This week United Nations officials declared that a famine in South Sudan is growing — fueled by a deadly combination of drought and conflict. They estimate that nearly 4 million people are already struggling to get enough food. And officials expect the famine will spread to more areas in the coming months affecting an additional 1 million people.
Meanwhile the threat of famine is looming over three other countries: Nigeria, Somalia and Yemen, putting a total of 1.4 million children at risk of death this year.
This week's warning follows several years of worrisome reports about droughts and food crises across Africa. And the frequency of these alerts can inure us to their seriousness. We're so used to hearing alarms about the risk of hunger that it can be hard to grasp when a situation has reached a truly catastrophic stage — as it has now.
To appreciate why the current alert is so momentous, it helps to understand who declares a famine — and what that actually means.
The determination — which was formally announced for one county in South Sudan last month and another one this month — is generally made jointly by several parties: the government of the affected country, various agencies of the United Nations and a "Famine Early Warning Systems Network" — called FEWSNET for short — that the U.S. government set up in the mid-1980s to collect and analyze data from a range of sources. FEWSNET draws from both survey data collected on the ground by aid agencies and governments as well as climate and satellite data provided by U.S. agencies like NASA and the National Oceanic and Atmospheric Administration.
The setup was developed in response to the devastating famines in East and West Africa in the 1980s — including one in Ethiopia that killed hundreds of thousands. The idea was to prevent such disasters by providing policymakers with a rating system that tells not just how severe a food crisis is but what needs to be done to keep it from escalating to the next level.
Today, officials use a five-phase scale to rank food crises that has been developed since the mid-2000s. It's not unlike the category system we use to characterize the power of a coming hurricane so that we can brace ourselves accordingly. And even at phase 1 — referred to as "minimal food insecurity" — the situation is troubling. No one is actually going without food just yet, but conditions are bad enough that as many as 1 in 5 households are only getting by thanks to aid money or because they're taking steps that could pose problems down the line. For instance, they're starting to sell off some of their cows, which could eventually make it hard for them to earn enough money to pay for food. This is the ideal point for governments and international donors to step in with aid to tide people over. Then once the crisis — say a drought or flooding – abates, people can quickly get back to normal.
But if there isn't enough help, the situation can quickly ratchet up to phase two where an area is considered "stressed" or to phase three, when it's considered in "crisis." At this point even with whatever aid is being provided at least one in five households is either taking drastic measures to get food or is actually cutting back on food. The drastic steps could involve selling off the last of their cattle, or eating seeds like maize kernels that they would normally plant for the next harvest. Also, for a situation to be considered level three, between 10 to 15 percent of the population is starting to suffer from what's called "acute malnutrition" — essentially the effects of not getting enough food.
By phase four the situation has reached the point of an "emergency." One in five households is either taking steps to get by that are so drastic they'll be impossible to sustain for much longer — or the family is already cutting back on food intake in major ways.
"People might start by protecting at least the main earners in the family — say the men who work in the fields — at the expense of the others," explains Yasmin Haque, UNICEF's deputy director of emergency operations. "So in a household that has extreme shortages of food you might see that first the mother starts to skip meals. Then it gets to the children. And then gradually you see the whole range of family members reducing their meals from three a day to two. And then maybe from a meal a day to a meal every two days."
And Haque notes that it's not just the frequency of the meals people are getting but the content of what they're eating. "In South Sudan, I've seen cases where women are boiling the bark and leaves of trees just to have something to feed their kids."
By this point as much as 30 percent of the population is also suffering from acute malnutrition. It often includes not just the moderate version but the severe form.
"People start looking skeletal," says Haque. "They have no reserves left in their body. The hair becomes bleached due to vitamin deficiency. The eyes get sunken." People find it harder to move. "Your immune system begins to suffer. Organ failure begins."
And yet this is still not a phase five "famine" situation. For that, three criteria need to be met: At least one in five households now faces an extreme lack of food, more than 30 percent of the population is suffering from acute malnutrition, and at least two people out of every 10,000 are dying each day.
That is the situation in two counties in South Sudan right now — with an estimated 80,000 people currently dealing with an extreme lack of food. And officials say that two more counties are at risk of reaching famine level soon. The problem is not just that there's a drought on but a civil war. Aid convoys and food warehouses have been attacked by both government and rebel forces.
Haque says the numbers of children suffering from the most severe form of acute malnutrition is particularly tragic. As of January UNICEF had treated 12,000 of them. And going forward officials there expect they'll be seeing as many as 25,000 additional cases each month. While treatment can keep a child from dying, Haque notes, it cannot undo the lasting damage from severe acute malnutrition. "It affects the growth of their intellect," she says. "The children are damaged for life. And the whole country is robbed of its potential."
ARI SHAPIRO, HOST:
This week, the United Nations declared that a famine in South Sudan is growing. Nearly 4 million people are already struggling to get enough food, and the U.N. warns that famine will get even worse in the coming months. This is not a new problem. People in South Sudan have been dying of starvation.
So NPR's global health and development correspondent Nurith Aizenman is here to help us understand where that line is between a really, really bad situation and an official declaration of famine. Hi, Nurith.
NURITH AIZENMAN, BYLINE: Hi.
SHAPIRO: So who decides when mass-starvation crosses that line and it officially becomes a famine?
AIZENMAN: So this is jointly decided by the government of the affected country, agencies of the United Nations. And then there's this special famine early warnings system network - it's called FEWSNET for short - that was created by the U.S. government in the mid-1980s to collect and analyze data from a whole range of sources to monitor the situations in countries.
SHAPIRO: What was going on at that point that made them decide to make this system?
AIZENMAN: This was really done in response to some devastating famines that occurred in East and West Africa in the '80s. A lot of people will probably remember the famine in Ethiopia that was catastrophic. And there was this feeling that the international community wanted to make sure that this never happened again by creating an early warning system. And the idea is not just to monitor how severe a food-crisis situation is but what needs to be done to make sure it doesn't reach the next level.
So the data comes in, and then it's ranked according to this five-point scale kind of like categories that we use to judge the severity of a coming hurricane. Well, this is a scale for judging a food crisis. One is minimal. Five is the magic point at which it's officially a famine.
SHAPIRO: Is that defined by the number of people who die or the percentage of the population that can't get enough food to eat? What are they actually measuring?
AIZENMAN: So they basically use three criteria to determine that it's actually reached that famine level. Number 1 - at least 1 in 5 households in a particular area are facing extreme food shortages. That means that they are skipping meals. They might be eating every other day.
Number 2 - more than 30 percent of people in the area are suffering what's called acute malnutrition. That means their body is now starting to feel the effects of not getting enough food. And in the moderate cases, that might just mean losing muscle tone, but in the severe cases, you know, you get that skeletal look. People's hair starts to turn sort of straw-like. They might not even be able to move very well. They start suffering organ failure.
And then criteria number three for it being a famine is at least 2 people per 10,000 in the population are actually dying every day of the effects of the malnutrition. So there's one region of the country where they declared already in January that there was famine. Now they're saying there's a second part of the country where this is happening, and they're warning that there are other areas that are also at risk.
SHAPIRO: Does a declaration of famine trigger specific things from the global community or from aid groups?
AIZENMAN: So it doesn't actually mandate a response. You know, there's no legal requirement, but it's a clear call to action that if immediate and major steps aren't taken, we're going to start to see a lot of death, widespread death. And the tragedy here is that it shouldn't have even gotten to this point because the whole idea of this early warning system is that before we get to that level-five famine, there are steps that could be taken to keep us from getting to that point, and those warnings weren't heeded.
SHAPIRO: Was that just because there was civil war? I mean what went wrong?
AIZENMAN: Yeah, in South Sudan, the issue has really been the conflict and the inability of humanitarian organizations to get to the people who need help and get them that help.
SHAPIRO: NPR's Nurith Aizenman, thanks a lot.
AIZENMAN: Glad to do it.
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