When does hunger become famine?

What is famine?

Whereas hunger, malnutrition, and food insecurity are all risk factors for personal and communal decline, the term famine is used to describe a societal catastrophe that requires urgent and coordinated humanitarian response to avoid widespread loss of life. 

The classification of famine is reserved for a specific confluence of factors: 

• at least 20 percent of the population faces extreme food shortages;
• acute malnutrition rates exceed 30 percent; and
• two out of 10,000 people die from starvation daily.

What is the difference between hunger, malnutrition, and famine?

Hunger is the physical pain or discomfort felt when a person does not consume enough calories. When hunger is chronic, it interferes with a person’s ability to lead a normal active and healthy life. 

Malnutrition is defined as the inability to take in enough food, or to fully utilize the food you eat. Illnesses such as diarrhea, measles, cholera, HIV, and tuberculosis can contribute to malnutrition.

Malnutrition is one of the single greatest threats to global public health and is particularly devastating for children, whose developing immune systems can be severely impaired by acute cases, making them more vulnerable to other diseases. 

Famine is a technical designation that applies when a population experiences extreme critical levels of acute malnutrition and mortality. 

What are the causes of famine?

Food insecurity

At present, the World Food Program estimates that this year, 309 million people will face acute levels of food insecurity, which is when people lack consistent access to enough nutritious food. This figure is not yet accounting for people in Sudan or Palestine, where analysis is soon expected on the effect of the ongoing conflicts. The organization also estimates that this year, 37.2 million people will face “emergency or worse levels” of acute food insecurity, requiring immediate emergency assistance to save lives.

The Food and Agriculture Organization and World Food Program have jointly warned that acute food insecurity is likely to deteriorate in several hunger “hotspots” between June and October 2024, including Haiti, Mali, Palestine, South Sudan, and Sudan.

The United Nations has also raised an alert on the situation in Gaza, where it reports one in five households go days without eating and the entire population is at “high risk” of famine. 

Climate change

Severe droughts and torrential flooding fueled by the effects of the climate crisis wreak havoc on agricultural lands, destroying crops and livestock. Many people can suddenly become food insecure and reliant on food aid. Diseases like malaria and cholera also thrive in floods caused by extreme weather, and people who are malnourished—especially children—are at higher risk of developing severe cases or even dying because their immune systems are already compromised.

In 2023, Somalia faced one of its worst droughts in 40 years, which made food less available while outbreaks of cholera and measles exacerbated the risks people with malnutrition face. In South Sudan, consecutive rainy season floods in recent years have destroyed the livelihoods of farmers and isolated communities, leading to severe malnutrition levels in some areas.

Conflict

Since Israeli forces began a total siege on Gaza last October, the entry of food and other essential supplies has been severely limited, leading to widespread hunger across the Strip. Supply routes into Gaza have been throttled, with an inspection process for trucks at the Rafah crossing taking four to five weeks on average in May. 

A report released in June estimates that 2.13 million Palestinians in Gaza, or 95 percent of the population, are currently experiencing acute food insecurity, and that “a high risk of famine persists across the whole Gaza Strip as long as conflict continues and humanitarian access is restricted.”

Even before the onset of the current war, most Palestinians living in Gaza were heavily dependent on aid for food and medical supplies due to shortages resulting from a 17-year blockade imposed by Israel. Nearly nine months later, malnutrition has become a serious threat. 

Before this war, MSF had never documented cases of malnutrition in our 36 years of working in Gaza. Today, we provide malnutrition screening and care in locations across the Strip, including at hospitals, health posts, and clinics in Al-Mawasi, Khan Younis, Rafah, and Deir al-Balah. 

When is famine declared?

The Integrated Food Security Phase Classification (IPC) is the benchmark by which governments and international organizations determine when a region is experiencing a famine. There are five stages to a famine classification, and each stage has appropriate action items to best respond to the problem. In the beginning stages of food insecurity, disaster risk reduction is appropriate, but in later stages urgent action is required to prevent damage to livelihoods and death.

Different governments, organizations, and entities may declare a famine based on their own information and methodology. MSF makes its own observations and declarations based on data collected on–the ground in our own medical humanitarian projects.

How does famine affect communities?

In Yemen, years of political instability and an economic crisis with high inflation have reduced people’s purchasing power so they can no longer afford enough nutritious food. Coupled with diminishing food aid distributions, including the suspension of the World Food Program’s general food distributions in northern Yemen, an already dire situation is worsening.

Of the pregnant women admitted to the maternity department of the MSF-supported Abs Hospital in February 2024, a massive 68 percent were malnourished. This impacts their ability to breastfeed, putting their children at higher risk of malnutrition as well.

Famine kills millions, including children

Malnutrition is particularly dangerous to children, potentially affecting their long-term development through stunting (low height for their age) and preventing them from reaching their full physical and cognitive potential. By weakening the immune system, malnutrition also makes people more vulnerable to dying from diseases that may not be fatal on their own. For children with malnutrition, contracting a disease like measles, for example, could kill them.

How does Doctors Without Borders help people experiencing malnutrition or famine? 

The World Food Program estimates that 42.3 million people are currently facing emergency levels of hunger. More than a million people are  suffering catastrophic hunger and “teetering on the brink of famine,” the majority of whom are in Gaza, South Sudan, and Mali.

In our projects, MSF teams diagnose malnutrition based on mid-upper arm circumference (MUAC) tests and treat it with ready-to-use therapeutic food (RUTF) like Plumpy’Nut, which contain all the necessary nutrients a child needs during development and helps them gain weight and reverse deficiencies. Patients with severe cases of malnutrition are admitted to inpatient or outpatient therapeutic feeding centers. We also take a preventative approach by distributing supplementary RUTF to at-risk children. These foods don’t require water for preparation, which eliminates the risk of contamination with waterborne diseases.