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    Famine and malnutrition

    Famine and malnutrition: Bring severely malnourished children back to health.

    About 12.2 million children have severe wasting, the deadliest form of malnutrition. For those who get it, a therapeutic food of peanuts, milk powder, vitamins and minerals, eaten at home, has a recovery rate of nearly 90%, by UNICEF's count. In Mali, curing a child cost about $191.

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    Ryan K. Hertel · heyitskenton

    The problem

    What we're up against.

    • Too thin to survive.

      About 42.8 million children are wasted, too thin for their height, and 12.2 million of them severely. Severe wasting makes a child about 12 times more likely to die.

    • Most still go untreated.

      Of the children with severe wasting, about half to two thirds go untreated. Treatment is growing: UNICEF-supported programs treated 9 million children in 2025, up from 5.4 million in 2021.

    • Where they live.

      More than three quarters of children with severe wasting live in Asia, and another 22% in Africa.

    • A share of child deaths.

      By UNICEF's estimate, around one in five deaths of children under five are linked to severe wasting.

    • Famine, at the extreme.

      In 2025, famine was confirmed in parts of the Gaza Strip and Sudan, and 35.5 million children were acutely malnourished across 23 countries and territories in nutrition crises. By the end of that year, no part of Gaza was still classified as in famine. In 2026, the IPC warned of a growing risk of famine in parts of Darfur and Kordofan in Sudan.

    What works

    Proven, and ready to grow.

    • A paste that brings children back.

      Ready-to-use therapeutic food is made from peanuts, skim milk powder, oil, sugar and essential vitamins and minerals, with 500 calories in each sachet. Compared with other diets, it probably makes recovery about 1.33 times as likely.

    • Simpler protocols treat more children.

      A simplified protocol worked as well as standard care using 122 sachets for each severe case instead of 193. In a trial in the Democratic Republic of the Congo, another simplified protocol had good outcomes for 72% of children, against 63%, at no extra cost.

    • Less food, same results.

      A lower dose of therapeutic food from the third week worked as well as the standard dose, even though close to 94% of the children came from homes severely short of food.

    • A lot of good for the money.

      Across studies, treatment cost $20 to $145 for each healthy year of life gained, and in one model for Zambia, deaths within a year fell from 20.8% without treatment to 9.2% with it.

    • Prevention works too.

      Small daily sachets of nutrient supplement cut severe wasting by 31%, and vitamin A cut child deaths by 12%.

    What a family could fund

    Where the money goes furthest.

    • The food is cheap.

      One carton of 150 sachets treats a child for six to eight weeks. UNICEF paid an average of $46.70 a carton in 2024, and a new agreement brings the price to $32.50 a box.

    • The full cost of a cure.

      With clinic staff, screening and medicine, curing a child cost about $191 in Mali, $92 in Somalia and $178 in South Sudan.

    • Vetted by GiveWell.

      GiveWell's grant of $4,787,985 to Taimaka in Nigeria was modeled to avert 1,128 deaths, and GiveWell has also funded ALIMA and the International Rescue Committee to treat malnutrition.

    • Matching what governments spend.

      UNICEF's Child Nutrition Fund matches what governments spend on these supplies one to one, and has unlocked $101 million for 18 countries, by its own count.

    • Factories ready, funding short.

      Factories could make four to five times as much therapeutic food as is funded, and humanitarian nutrition programs were $473 million short for the last four months of 2025.

    Honest limits

    What money can't promise.

    • Many children relapse.

      Within six months of recovering, 30% of children relapsed in Mali, 63% in South Sudan and 22% in Somalia, and treating a relapse costs, on average, about twice as much as the first cure.

    • Lives saved are hard to count.

      It's widely considered unethical to study malnourished children without treating them, so no one measures it directly. GiveWell estimates that 3% to 19% of untreated children die, depending on where they live.

    • Conflict blocks the way.

      In Sudan, health care is extremely limited and often entirely out of reach, and in crises like these, humanitarian help alone can't reverse hunger.

    • Supply chains break.

      Up to 80% of the money for therapeutic food comes from emergency budgets, and UNICEF has warned of stockouts in Mali, Nigeria, Niger and Chad.

    • Treating isn't preventing.

      Over a year, about 3.6 times as many children fall severely ill as are ill on any one day, and nine in ten children treated are in emergencies, though three quarters of severely wasted children live elsewhere.

    Hard questions

    Asked and answered.

    1. You might ask

      Doesn't food aid create dependence?

      Ryan

      Treatment is a short course, one carton over six to eight weeks, not an ongoing ration. And a review of the evidence on food aid found that much of what's cited as proof of dependency doesn't show cause and effect.

    2. You might ask

      Why not fix the root causes instead?

      Ryan

      Do both. Prevention works: small nutrient supplements cut severe wasting by about 31%. But a child who is severely wasted today can't wait for the root causes to be fixed.

    3. You might ask

      Does treatment just delay death?

      Ryan

      Mostly, no. In one large trial, 1.8% of children in treatment died, and a long follow-up in Malawi found catch-up growth and the potential for near-full recovery, though some lasting effects remained.

    In the slider

    See what your fortune could do here.

    Famine and malnutrition

    The slider prices this cause with these numbers:

    • About $191 treats a severely malnourished child through to recovery, in a recent field costing in Mali.
    • The whole need is every child with severe wasting, the deadliest form, 12.2 million children at any one time.
    • Costs vary widely by place, from $103 to $1,267 per child treated across studies, and more children fall ill over a year than are sick on any one day, so this need is cautious.
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    More of the Blueprint

    Keep reading.

    23 more chapters on the way

    Back to Keep 100

    Sources

    Every number in this chapter, and where it came from.

    1. Source 1: Fast facts: 30 years of life-saving therapeutic food for children, yet millions more still need it (opens in a new tab)

      UNICEF, 4 May 2026. Checked 16 October 2026.

    2. Source 2: The Economic Implications of Relapse Among Children Recovered from Severe Acute Malnutrition (Puett and others) (opens in a new tab)

      Current Developments in Nutrition, 10 December 2025. Checked 16 October 2026.

      Field costing in Mali, Somalia and South Sudan, in 2022 dollars.

    3. Source 3: Ready-to-Use Therapeutic Food: Market and Supply Update (opens in a new tab)

      UNICEF Supply Division, December 2025. Checked 16 October 2026.

    4. Source 4: Global Annual Results Report 2025: Goal Area 1 (Nutrition) (opens in a new tab)

      UNICEF, July 2026. Checked 16 October 2026.

      UNICEF's own results.

    5. Source 5: Joint Child Malnutrition Estimates (UNICEF, WHO and World Bank): latest estimates (opens in a new tab)

      World Health Organization, 21 July 2025. Checked 16 October 2026.

    6. Source 6: Child Alert: Severe wasting (opens in a new tab)

      UNICEF, May 2022. Checked 16 October 2026.

    7. Source 7: Food crises: no respite as 1.4 m people suffer the most severe level of food insecurity in 2025 (opens in a new tab)

      European Commission Joint Research Centre, 24 April 2026. Checked 16 October 2026.

      On the Global Report on Food Crises 2026.

    8. Source 8: Gaza famine pushed back, but millions still face hunger and malnutrition, UN says (opens in a new tab)

      UN News, 19 December 2025. Checked 16 October 2026.

    9. Source 9: IPC Sudan Food Insecurity and Malnutrition Alert (opens in a new tab)

      World Health Organization, 12 October 2026. Checked 16 October 2026.

    10. Source 10: Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age (Schoonees and others) (opens in a new tab)

      Cochrane Database of Systematic Reviews, 15 May 2019. Checked 16 October 2026.

    11. Source 11: A simplified, combined protocol versus standard treatment for acute malnutrition in children 6-59 months (ComPAS trial) (Bailey and others) (opens in a new tab)

      PLOS Medicine, 9 July 2020. Checked 16 October 2026.

      A cluster randomized trial in Kenya and South Sudan.

    12. Source 12: Simplifying and optimising the management of uncomplicated acute malnutrition in children aged 6-59 months in the Democratic Republic of the Congo (OptiMA-DRC) (Cazes and others) (opens in a new tab)

      The Lancet Global Health, April 2022. Checked 16 October 2026.

      A randomized trial.

    13. Source 13: Cost-effectiveness of a simplified acute malnutrition program: a secondary analysis of the OptiMA randomized clinical trial (Resch and others) (opens in a new tab)

      Health Policy and Planning, March 2025. Checked 16 October 2026.

    14. Source 14: Effectiveness of a reduced dose of ready-to-use therapeutic food in community-based management of severe acute malnutrition: A non-inferiority randomized controlled trial in the Democratic Republic of Congo (Ntaongo Alendi and others) (opens in a new tab)

      PLOS Medicine, 16 May 2025. Checked 16 October 2026.

      A randomized trial with 968 children.

    15. Source 15: Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review (Mdege and others) (opens in a new tab)

      PLOS Global Public Health, 8 November 2023. Checked 16 October 2026.

    16. Source 16: Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model (Bachmann) (opens in a new tab)

      Cost Effectiveness and Resource Allocation, 15 January 2009. Checked 16 October 2026.

      A model, not a trial.

    17. Source 17: Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials (Dewey and others) (opens in a new tab)

      The American Journal of Clinical Nutrition, November 2022. Checked 16 October 2026.

      Pools 14 randomized trials.

    18. Source 18: Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age (Imdad and others) (opens in a new tab)

      Cochrane Database of Systematic Reviews, 16 March 2022. Checked 16 October 2026.

    19. Source 19: New agreement cuts the price of life-saving malnutrition treatment by 30%, enough to reach a million more children without spending a single new donor dollar (opens in a new tab)

      Clinton Health Access Initiative, 11 August 2026. Checked 16 October 2026.

      The organization's own account.

    20. Source 20: Taimaka: Acute Malnutrition Treatment in Gombe State, Nigeria (November 2024) and Program Monitoring (March 2025) (opens in a new tab)

      GiveWell, June 2025. Checked 16 October 2026.

      GiveWell's own model of the grant.

    21. Source 21: Alliance for International Medical Action: Malnutrition (Chad, May 2021; Niger and Nigeria, November 2022) (opens in a new tab)

      GiveWell, March 2024. Checked 16 October 2026.

    22. Source 22: International Rescue Committee: Malnutrition Treatment (January 2024) (opens in a new tab)

      GiveWell, April 2024. Checked 16 October 2026.

    23. Source 23: The Match Window (opens in a new tab)

      UNICEF Child Nutrition Fund. Checked 16 October 2026.

      The fund's own account.

    24. Source 24: Millions at Risk: UNGA 80 Must Respond to the Child Wasting Emergency (opens in a new tab)

      Wasting Advocacy Coalition and Global Nutrition Cluster, 23 September 2025. Checked 16 October 2026.

      A joint statement. The funding figures are the Global Nutrition Cluster's own.

    25. Source 25: Rates and risk factors for relapse among children recovered from severe acute malnutrition in Mali, South Sudan, and Somalia: a prospective cohort study (King and others) (opens in a new tab)

      The Lancet Global Health, January 2025. Checked 16 October 2026.

    26. Source 26: Community-Based Management of Acute Malnutrition (opens in a new tab)

      GiveWell, March 2024. Checked 16 October 2026.

    27. Source 27: Nearly two million severely malnourished children at risk of death due to funding shortages for therapeutic food (opens in a new tab)

      UNICEF, 14 October 2024. Checked 16 October 2026.

    28. Source 28: Improving estimates of the burden of severe wasting: analysis of secondary prevalence and incidence data from 352 sites (Isanaka and others) (opens in a new tab)

      BMJ Global Health, March 2021. Checked 16 October 2026.

      More children fall ill over a year than are sick on any one day.

    29. Source 29: Food Aid and Dependency: Implications for Emergency Food Security Assessments (Lentz, Barrett and Hoddinott) (opens in a new tab)

      SSRN, 2008. Checked 16 October 2026.

      A review of the evidence on food aid in general, not on therapeutic food.

    30. Source 30: Chronic disease outcomes after severe acute malnutrition in Malawian children (ChroSAM): a cohort study (Lelijveld and others) (opens in a new tab)

      The Lancet Global Health, 25 July 2016. Checked 16 October 2026.

      Followed children for about seven years after treatment.