What life looks like on the ground in 15 fragile states

Each year, the Fragile States Index shows many ups and downs. Much of our reporting chronicles these ups and downs, but as experienced by some of the most vulnerable civilians within those states.

Many of these people’s lives are buffeted by the “indicators” that build the FSI rankings – and sometimes they can count themselves among those indicators: refugees and IDPs, human flight and brain drain.

While we look for ups and downs, the “downs” usually overwhelm the “ups”. 

One positive story this year, by the numbers at least, is Ethiopia: it ranks as “most-improved” – though still firmly in the FSI “alert” category. Two years ago, it was “most-worsened”. Good news, surely.

Yet, on the ground, life may not feel too different than it did back in 2017 — at least not yet. Despite reforms ushered in by Prime Minister Abiy Ahmed, a peace settlement with Eritrea, and a generally hopeful outlook on many fronts, the situation for many remains dire. Drivers of humanitarian crises, such as inter-communal conflict and drought leading to food insecurity, are very much present.

Here’s what that looks like for people like Tegeno Tiba, 86, an ethnic Gedeo displaced from the country’s Oromia region: “During the day it seems peaceful,” he told The New Humanitarian recently. “But at night they come in mobs, singing and dancing,” he said, describing the groups of armed men who taunted him and others. “You can hear gunshots, and they throw stones.” Tiba is among more than a million Ethiopians who are still displaced as ethnic tensions are rising.

Below, we offer by-the-numbers and on-the-ground looks at 15 countries on the FSI, along with collections of our recent reporting. The countries include 10 ranked as “most fragile” and five others that are deemed less fragile but are dealing with key humanitarian crises – from Mali to Venezuela.

The Fragile States Index, produced by the NGO Fund for Peace, ranks 178 countries based on 12 indicators. For each indicator it gives a score out of 10, with 10 being the most fragile and zero being the least fragile. The higher the score and the higher the ranking, the higher the level of fragility. Unsurprisingly, the states ranked as most fragile are also home to some of the world’s most pressing humanitarian crises: Yemen, you won’t be surprised to learn, tops the list this year. For an idea of what that means on the ground, read on.

 

The “world’s worst” humanitarian crisis

“Let’s say the war ends tomorrow – it’s going to be a massive task because you have to rebuild all the infrastructure.”

FSI ranking: 1 (score: 113.5/120)

 

Yemen – labelled “the world’s worst humanitarian crisis” by the UN and now in its fifth year of conflict – is ranked as the world’s most fragile state. The 2019 FSI scores the Middle East’s poorest country with a full 10 points for security, factionalised elites, and external intervention. It is the fourth “most-worsened” state in the last decade of the index (behind Libya, Syria, and Mali) and has been on a rapid downward trajectory from a comparatively stable 24th in 2007.

 

“Yemen is a vast country with a lot of different issues and there are a number of deep-rooted existing conflicts within this new macro conflict which escalated four years ago,” Sultana Begum, advocacy manager for the Norwegian Refugee Council in Yemen, told TNH. “It has also become a proxy war for external actors, and that’s where it gets very complicated.”

 

Describing the economy and public services as at “breaking point”, Begum said the conflict had reversed most of the development gains made in recent years and greatly increased Yemen’s fragility. “This is what’s really worrying,” she said. “Let’s say the war ends tomorrow – it’s going to be a massive task because you have to rebuild all the infrastructure. Everything has been hit; nothing has been spared – the markets, the schools, the water infrastructure, the roads, the bridges – all these things have to be built up again.”

 

Much in the short term hinges on a shaky ceasefire in Hodeidah, the entry point for most of Yemen’s humanitarian aid and commercial imports. As Salem Jaffer Baobaid, a Yemeni aid worker in the port city, explained late last year in this essay, Bringing aid to my neighbours in Hodeidah just got harder: “Without an end to this war, many more innocent people will die – be it from hunger, like the people I help; from disease, like my wife; or from the bombs and bullets that are edging ever closer to me.”

At a glance:

24 million people – approximately 80 percent of the population – are in need of aid

The UN says more than 4,800 civilians were killed or injured in 2018

More than half the population is facing severe acute food insecurity

Endemic cholera, with some 1.5 million suspected cases since October 2016

National GDP contracted by an estimated 39 percent since 2014

More than three million Yemenis are internally displaced

 

 

Fixed Fragility

“The layers of violence that people have had to digest is one of the key problems for building a peaceful and healthier society.”

FSI ranking: 2 (112.3/120)

One of the most complex and long-standing humanitarian crises in the world, Somalia has consistently been ranked the most or second-most fragile country in the FSI since 2008. Poverty and cyclical climatic shocks such as drought and floods have driven parts of the country to the brink of starvation. Famine was last seen between 2010 and 2012, when an estimated 260,000 people died, half of them children under five. Complicating these risks and deepening the crisis is a violent Islamist insurgency and associated political instability.

“The layers of violence that people have had to digest is one of the key problems for building a peaceful and healthier society,” Laetitia Bader, a senior researcher at Human Rights Watch, told Somali‐Canadian journalist Hassan Ghedi Santur in this report for TNH from Mogadishu about the legacy of decades of conflict on the nation’s children.

At a glance:

One third of Somalis, or 4.2 million people, need humanitarian assistance and protection

More than 1.5 million people live with acute levels of food insecurity (IPC 3+)

More than 2.6 million people have been internally displaced by armed conflict and violence, insecurity, and/or drought and floods

An estimated two million people live in hard-to-reach, conflict-affected areas

 

 

The most dangerous place for aid workers

“The consequences of what’s happening will be felt for the whole generation of kids growing up.”

FSI ranking: 3 (112.2/120)

The world’s youngest nation, South Sudan came into being less than 10 years ago, after a decades-long conflict and secession battle within Sudan. Since gaining its independence in 2011, it has barely seen two full years of peace, and its FSI ranking of 3 reflects its many challenges. The country scores particularly badly on security, state legitimacy, its high numbers of refugees, as well as its weak economy and poor public services.

Insecurity is a major problem for agencies responding to crisis in South Sudan. The country is ranked the most dangerous place for aid workers, and in 2017 accounted for more than a third of all attacks on humanitarians globally.

Last year's revitalised peace agreement has provided cautious optimism that the country will be given a chance to rebuild, but on the ground the effects of the agreement are not always visible. “The level of disaster is enormous… The consequences of what’s happening will be felt for the whole generation of kids growing up,” Koen Sevenants, a psychologist with the International Organisation for Migration, told TNH earlier this year.

At a glance:

Half the population – around seven million – is in need of humanitarian assistance

An estimated 400,000 people have died since the start of civil war in 2013

More than 2.4 million are living as refugees in neighbouring countries

Just under two million people have been internally displaced

 

 

No quick recovery even if conflict ends

“I’m tired of this, I’m really tired. I want to live in a normal situation, in a normal place, with normal people. Everybody is tired of this war.”

FSI ranking: 4 (111.5/120)

Syria, now in its ninth year of civil war, has been ranked as the fourth most fragile country for the second-year running. It has been among the 10 most fragile since 2015, but less than a decade ago the country was ranked a comfortable 48th. In 2019, Syria scored a full 10 on indicators concerning group grievance, human rights, refugees and IDPs, and external intervention.

Even with the last remaining territory of so-called Islamic State finally being liberated, there is no sign of the humanitarian caseload reducing. Trade and other sanctions placed on Syria by the United States and the European Union, among others, are increasingly isolating the country economically, pushing up food prices and creating shortages of fuel and other basic goods. Public infrastructure has been shattered, basic services are limited, and more than 80 percent of the population lives below the poverty line. As Rajaai Bourhan, a former business student who now ekes out a living as a freelance journalist in northwestern Syria, told TNH in September: “I’m tired of this, I’m really tired. I want to live in a normal situation, in a normal place, with normal people. Everybody is tired of this war.”

Yakzan Shishakly, CEO of the Maram Foundation for Relief & Development, a Syrian NGO, described Syria’s “systemic weaknesses” as a “grave cause for concern”. He told TNH: “If unaddressed, these pockets of power vacuums will remain increasingly vulnerable to exploitation by extremist forces, which may hurl Syria back into the violence and destruction witnessed during the last eight years.”

In parts of Syria, meanwhile, those displaced by the conflict are returning and trying to rebuild lives. For example, in the old town of Aleppo, devastated in 2016 in the final throes of a years-long siege, Mohamed has reopened his shop that sells roasted nuts and seeds. “After three years in Turkey, I came back within days of Aleppo being liberated,” he told TNH. “All that time, I was just waiting to come back because this shop has been in my family for three generations. The roof was caved in, but luckily the equipment had survived.”

At a glance:

An estimated 11.7 million people are in need of humanitarian assistance

Some 6.5 million Syrians are food insecure, and a further 2.5 million are at risk of food insecurity

The country experienced its worst drought in 30 years in 2017/2018, impacting the already fractured agricultural systems

 

 

Ten percent of the global humanitarian caseload

“Throughout the region, health workers have fled their posts. Within health centres that are still operational, there isn’t enough medical supplies or medications to meet local health needs.”

FSI ranking: 5 (110.2/120)

The Democratic Republic of Congo, currently grappling with the second-deadliest Ebola outbreak in history, has been ranked within the most 10 fragile countries since the FSI began 15 years ago. It has been on a declining pathway for the last three years.

The country, which has been dogged by decades of conflict, fuelled by regional rivals, scores a full 10 for group grievance and displacement, although it has shown a slight improvement in terms of perceptions of state legitimacy. The departure of president Joseph Kabila in 2019 ends more than two decades of one-family rule, but Felix Tshisekedi’s election was mired in controversy and may lead to more insecurity.

During a visit to DRC in March this year, UN humanitarian chief Mark Lowcock listed the combination of “disease outbreaks, conflict, natural disasters, and sexual violence” as some of the challenges that prevented “the men, women and children of the DRC from fulfilling their full potential and ma(de) the humanitarian crisis in the country so uniquely complex”.

Here’s what that looks like to Timothée Mukendi, a civil servant in the southern Kasai region, where the mass graves and massacres of 2017 have given way to general insecurity marked by banditry, military abuses, and – after two years of poor harvests – hunger and malnourishment: it takes months for him and his colleagues to receive salaries, he said, and they sleep on floor mats and struggle to find food. As ALIMA, an NGO that pools international expertise to provide medical help in crisis zones, explained: “Throughout the Kasai region, health workers have fled their posts. Within health centres that are still operational, there isn’t enough medical supplies or medications to meet local health needs.”

At a glance:

12.8 million people are in need of humanitarian assistance – accounting for 10 percent of the global humanitarian caseload

More than 600 deaths in ongoing Ebola outbreak, the second-deadliest ever

Severe acute malnutrition (SAM) affects more than 1.3 million children

Nearly 1,000 cholera deaths in 2018

2.1 million people have been internally displaced

 

 

‘One of the world’s most fractured states’

“The Central African Republic is important. It matters. The lives of the people who live there matter.”

FSI ranking: 6 (108.9/120)

CAR – home to one of the world’s most overlooked and least understood conflicts – is ranked sixth in the FSI, scoring a full 10 for its refugee and IDP situation and its lack of public services. The country has slightly improved (on the security and factionalised elites indicators) since 2017, when it was ranked third, with a score of 112.6.

Decades of conflict and political turmoil – due to deep-rooted ethnic, socio-economic, and geographic cleavages – have ravaged CAR, which is rich in natural resources yet one of the world’s poorest countries. For parents like Sadia Tacko, whose daughter has been ill since birth, that often means they are unable to care for their children as they would like. “Médecins Sans Frontières used to give us a lot of medicine,” she told TNH last year, “but since they left [due to the violence] that has stopped. I am very worried. I need to take her to the central hospital so she can get proper treatment, but the self-defence militia prevents us from going.”

Stories like Tacko’s also rarely get told because of media neglect. But as journalist Philip Kleinfeld told TNH last June after five weeks in CAR interviewing UN peacekeepers, warlords, aid workers, and civilians: “The Central African Republic is important. It matters. The lives of the people who live there matter.”

CAR is one of the most dangerous operating environments for humanitarian workers, with nearly 400 security incidents affecting aid organisations and their staff in 2018 and two deaths already in 2019. A new peace deal signed in February offers some hope, but failure “will further solidify CAR’s place as one of the world’s most fractured states”, warns J Tyler Lycan, a US-based researcher focusing on CAR, writing in TNH in March.

At a glance:

2.9 million people are in need humanitarian assistance

One in four people are displaced, either internally or in a neighbouring country

Nearly half the population is food insecure

Ongoing epidemics include viral hepatitis E; bloody diarrhoea; measles; and monkeypox

Conflict-related sexual violence is endemic, with nearly 8,000 reported incidents in 2018

 

 

Surrounded by conflict and militancy

“I think more attention needs to be paid… to what 400,000 refugees represent to the government of Chad, because it’s a country that’s quite poor, where the standards of living, health, water, and education are very low.”

FSI ranking: 7 (108.5/120)

Chad – at the heart of the heavily militarised Sahel region — has been among the world’s most fragile states since the start of the FSI, and occupied the second worst slot in 2010 and 2011. Marked deteriorations on the state legitimacy, group grievance, and factionalised elites indicators have pushed it up from eighth to seventh on the fragility rankings for 2019, despite better scores for public services and demographic pressures.

Accelerating urbanism driven by climate change and conflict-related displacement, coupled with insufficient infrastructure and poverty, have taken their toll on Chad’s rapidly growing young population, many of whom – in the absence of meaningful employment and economic opportunity – are being lured into criminality and religious extremism. Chad’s proximity to Sudan’s Darfur region as well as to CAR and the Boko Haram insurgency in northeastern Nigeria means it also struggles to cope with several hundred thousand refugees from neighbouring countries. As the UN refugee agency’s representative in Chad, Antonio Canhandula, told TNH: “I think more attention needs to be paid… to what 400,000 refugees represent to the government of Chad, because it’s a country that’s quite poor, where the standards of living, health, water, and education are very low.”

At a glance:

4.3 million people are in need of humanitarian assistance

3.7 million people are food insecure

124,000 people are internally displaced

The country is hosting 450,000 (mostly Sudanese) refugees

 

 

Protests point to further upheaval

“What we're seeing right now might not be the final chapter, but we are nearing the end."

FSI ranking: 8 (108/120)

Sudan – a complex fabric of civil conflict and insurgency exacerbated by climate pressures and a violent dictatorship – has been among the 10 most fragile states for the last 15 years. It was ranked the most fragile in 2006 and 2007, but has been improving slowly since, reaching an historic best of eighth for 2019. Gains have been made on indicators such as external intervention, brain drain and human flight, and public services, although this year it slipped on state legitimacy, human rights, and demographic pressures.

Sudan’s humanitarian needs are primarily caused by poverty, underdevelopment, and climatic factors (including unpredictable rainfall patterns and drought, which affect crop yields and food supplies), but conflict and border tensions also play a part in displacement and food insecurity. The situation is most critical in Darfur and in the southern Blue Nile and South Kordofan states.

Parts of the latter two areas have been largely inaccessible to humanitarian agencies due to brutal counter-insurgency operations by Sudanese government forces and allied militias. Access was supposed to improve following the easing of international sanctions against President Omar al-Bashir, who has been in power since 1989 and is wanted by the International Criminal Court on charges of crimes against humanity and genocide. Street protests in Khartoum against al-Bashir have swelled in 2019, and some are predicting greater upheaval ahead. As Horn of Africa expert Harry Verhoeven told TNH in January: "Since 2011 people have known the time is up, it's a question of when rather than if. What we're seeing right now might not be the final chapter, but we are nearing the end."

At a glance:

5.7 million people are in need of humanitarian assistance

2.5 million children under five are malnourished

1.86 million people have been internally displaced

Hosts 1.2 million refugees, mostly from South Sudan, Eritrea, Ethiopia, Somalia, and Yemen

 

 

A textbook case of fragility

“We’ve had a bad drought, followed by the worst floods I’ve seen here in decades. People’s entire livelihoods have been swept away.”

FSI ranking: 9 (105.0/120)

Decades of protracted conflict, Islamist extremism, weak governance, and chronic under-development all contribute to make Afghanistan a textbook case of fragility. The country has ranked among the 10 most fragile on the FSI for the past 15 years. It has been stuck at 9th for the last four years in a row, despite slight improvements to its score on a combination of indicators including human rights, external intervention, public services, group grievance, and economy.

In addition to the continued violence and use of landmines and other explosive devices – which have left a visible legacy of physical disabilities among the population and resulted in more civilian casualties than in any year since records began – Afghanistan is also on the front line of climate change. Sudden heavy rainfall earlier this year came on the back of a prolonged drought, and flash floods across nine provinces swept away thousands of homes across and killed dozens of people. “We’ve had a bad drought, followed by the worst floods I’ve seen here in decades. People’s entire livelihoods have been swept away,” Ayub Omar Omari, a district governor in Helmand province, told TNH.

At a glance:

6.3 million people are in need of humanitarian assistance

3.6 million people are at emergency levels of food insecurity

10,993 civilian casualties (3,804 deaths and 7,189 injured) from conflict in 2018

More than half a million people were displaced by conflict and/or drought during 2018

 

 

Shortages and protests

March’s Cyclone Idai “compounds an already dire situation”.

 FSI ranking: 10 (99.5/120)

Despite being one of the most improved on the fragility score over the last decade (reducing its overall score by 14.5), Zimbabwe remains among the world’s 10 most fragile states. This is, however, a marked improvement on its second and third-place rankings in 2009 and 2008 (respectively). In the last 12 months in particular, the country has posted better scores regarding security, economy, group grievance, and external intervention, but still remains far from the rank of 16th that it held in 2015 and 2016.

The departure in 2017 of long-serving president Robert Mugabe was widely celebrated – but only briefly. His replacement, Emmerson Mnangagwa, is struggling to manage the fragile economic situation, which has sparked widespread civil protests due to shortages in food, fuel, and basic medical supplies.

March’s Cyclone Idai – the worst in Zimbabwe’s history – “compounds an already dire situation, as the hardest-hit areas were facing severe food insecurity and economic hardships prior to the cyclone,” according to Paolo Cernuschi, Zimbabwe country director at the International Rescue Committee.

At a glance:

5.3 million people were in need of humanitarian aid before Cyclone Idai

2.9 million people are severely food insecure (IPC phase 3 or 4)

More than 1.3 million people – approximately 13 percent of Zimbabweans – live with HIV

Cyclone Idai left at least 4,500 displaced, 172 dead, and more than 180 injured

 

 

Humanitarian needs have doubled

“Schools have become targets.”

FSI ranking: 16 (97/120)

Cameroon rose seven places in the FSI rankings in 2019, to 16th from 23rd, and from 36th in 2006. The country – where calls for autonomy from an anglophone minority led to protests, crackdowns, violent clashes, and now an armed rebellion – scored badly on indicators including security, factionalised elites, group grievance, state legitimacy, and displacement.

Humanitarian needs have almost doubled in the space of the last 12 months, with displacement rising by 82 percent compared with 2018, according to the UN. The recent surge in violence has compounded existing fragilities, with many farming families displaced or unable to access their fields and markets, which has had a negative impact on food security. The country is already hosting nearly 400,000 refugees, many of whom have fled the Boko Haram insurgency and other conflicts in neighbouring countries.

Education has been a major casualty of the unrest, with dozens of schools attacked and tens of thousands of children now missing lessons. “Schools have become targets,” noted a July 2018 Human Rights Watch report: “Either because of … threats, or as a show of solidarity by parents and with the separatist cause, or both, school enrolment levels have dropped precipitously during the crisis.”

At a glance:

4.3 million people are in need of humanitarian aid

More than 500,000 people have been internally displaced

385,000 refugees from neighbouring countries are taking refuge in Cameroon

 

 

Where inter-communal conflict meets militancy

We’re at the centre of a storm affecting all the Sahel, from Burkina Faso to Mali, Nigeria, Chad, and Libya.”

FSI ranking: 18 (96.2/120)

Impoverished Niger, which has become a smuggling hub for many Africans trying to migrate to Europe, rose three places to 18th in the 2019 index. Its overall score remained the same, with a higher tally on the security indicator balanced out by a stronger economic performance. The country, which ranked 44th as recently as 2006, has been hovering around 20th spot for the past few years. This is due to mounting climatic pressures, inter-communal conflict forcing people from their land, and an overspill of militancy and extremist insurgency from neighbouring countries, such as Mali, Nigeria, and Burkina Faso.

Attacks on civilians have risen sharply in the past five months. According to the Armed Conflict Location & Event Data Project, ACLED, there were 63 attacks resulting in 78 reported fatalities, a 600 percent increase on the same period a year earlier. This has compounded existing tensions in the Diffa region, where attacks and displacement are common due to Boko Haram insurgency across the border in Nigeria.

We’re at the centre of a storm affecting all the Sahel, from Burkina Faso to Mali, Nigeria, Chad, and Libya,” Niger’s defence minister Kalla Moutari told TNH.

At a glance:

2.3 million people are in need of humanitarian assistance

1.8 million people are in need of nutritional support

717,000 people are “in a vulnerable situation along Niger’s border with Mali and Burkina Faso”

254,000 people are internally displaced

178,000 refugee, mostly Nigerians fleeing Boko Haram violence, are taking shelter

 

 

A rapid deterioration in fragility

“The needs are huge.”

FSI ranking: 21 (94.5/120)

Mali – currently experiencing a fresh surge in fighting between al-Qaeda-linked extremists, self-defence militias, and government soldiers – climbed six places in the fragility rankings from 27th to 21st this year. Mali had a ranking of 90th as recently as 2007 – a reflection of the country’s rapid deterioration since a 2012 uprising by separatist Tuareg rebels.

Mali scored particularly badly this year in terms of group grievance, demographic pressures, human rights, and state legitimacy. The FSI classes it as the third “most-worsened” country over the last decade, after Libya and Syria (just ahead of Yemen, this year’s most fragile).“The needs are huge,” Hassane Hamadou, Mali country director at the Norwegian Refugee Council, told TNH in March, but a lack of funds and an increasingly militarised landscape is complicating delivery, while attacks on humanitarian workers are on the rise.

At a glance:

3.2 million people are in need humanitarian assistance

Internal displacement has tripled over the past year, to 123,000 people

More than 2.5 million people – around 13 percent of the population – are food insecure

 

 

Resilience or volatility?

“You’ve got millions of people displaced – it’s a humanitarian crisis, and it could get out of control.”

FSI ranking: 23 (94.2/120)

Ethiopia is ranked the 23rd most fragile state and is firmly within the FSI alert category. But it was also the most-improved country in the 2019 index, based on indicators for security, state legitimacy, and human flight and brain drain, jumping from 15th in 2018. This appears to reflect the ambitious reform agenda of new Prime Minister Abiy Ahmed and a settlement with Eritrea, with which it had been technically at war. Significantly though, its improvement comes just two years after Ethiopia was labelled the “most-worsened” country in the 2017 FSI, when its score rose sharply due to poorer numbers on public services, human rights, and group grievance – an indicator of the country’s volatility.

Despite the headline reforms and welcomed realignment of power structures, tensions are rising within Ethiopia, home to more than 80 ethnic groups. The population of internally displaced people mushroomed to more than two million at the end of last year, driven by both inter-communal conflict as well as prolonged drought. More than 1.4 million Ethiopians were forced from their homes in the first half of last year alone – the largest internal displacement anywhere in the world in 2018.

Ethnic tensions are the biggest problem for Ethiopia right now,” Tewodrose Tirfe, chair of the Amhara Association of America, a US-based advocacy group that played a significant role in lobbying the US government to censure the former regime, told TNH in January. “You’ve got millions of people displaced – it’s a humanitarian crisis, and it could get out of control.”

At a glance:

Conflict displaced an estimated 1.77 million people in 2018

Climate-inducted factors created an additional half a million IDPs

8.9 million people are in need of humanitarian aid

Seven million people are in acute food insecurity

 

 

Fragility in freefall

“Malnourished children are dying here – yes, in my community they are starving to death.”

FSI ranking: 32 (89.3/120)

Oil-rich Venezuela – currently in the grip of a socioeconomic and political crisis that has driven somewhere between three and four million people to leave the country since 2015 – is the worst overall performer in the 2019 index. Perhaps surprisingly it is not among the 10 most fragile states, but Venezuela has moved from a ranking of 46th to 32nd, marking its sixth consecutive year of increasing fragility, and a huge deterioration from 89th in 2013. Venezuela is the “most-worsened” country in the FSI over the last five years and the fifth “most-worsened” over the last decade – after Libya, Syria, Mali, and Yemen.

The government of Nicolás Maduro has refused to call the country’s overall situation a humanitarian crisis, and has repeatedly rejected international aid, preventing the UN and other international agencies from assessing the extent of the need. This is despite pervasive hunger; the resurgence of diseases like diphtheria, measles, malaria, and TB; an absence of basic medicines; and electrical blackouts that have led to water shortages and mass lootings.

“We have lost a lot of kids here to malaria and hepatitis,” says Leidis Vallenilla, a 60-year-old resident of a small town called Cerezal. “You can see people whose eyes and lips have turned orange. But worst of all is malnutrition. Malnourished children are dying here – yes, in my community they are starving to death,” she told TNH.

At a glance*:

At least 3.4 million people have left the country since 2015

More than 9,300 cases of measles have been reported since June 2017

Some 80 percent of households are food insecure

*Due to the blockade on international aid organisations and irregular government updates, these are estimates based on collated local reports.

 

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