Greater Horn of Africa (Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda), Grade 3 Emergency Appeal (March 2023)

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Estimated Total Population: 294 million (World Bank)

Acutely Food Insecure Population (high level): 46.3 million (IPC 3+ crisis or worse)

Number of Refugees: 4.5 million (UNHCR)

Internally Displaced People: 13.5 million (UNHCR)

Estimated acutely malnourished children (under 5 years): 1.8 million (Somalia), 1.4 million (South Sudan), 884k (Kenya) and 104K (Uganda)

Estimated severely acute malnourished children (under 5 years): 514k (Somalia), 346k (South Sudan), 223k (Kenya) and 16.5k (Uganda).

WHO steering 4 health clusters and coordinating 262 partners in service of 21.5 million people (Ethiopia, Sudan, South Sudan and Somalia)

Attacks on health care: 73 attacks, 113 injuries, 93 deaths (Jan 21-Dec 22 in 3 countries)

Under- five mortality rate (per 1,000 live births, IGME 2020): Somalia 115, South Sudan 98, Sudan 57

Ongoing outbreaks as of 16 December 2022: Measles (6 countries), Cholera (4 countries), Yellow Fever (2 countries), Mpox, Hepatitis E, Polio, Dengue, Anthrax, Malaria, Ebola disease (caused by Sudan virus)

Funding requirements: US$ 178 million (Jan-Dec 2023)


The Greater Horn of Africa is one of the world’s most vulnerable geographical areas in relation to impacts of climate change and is currently experiencing one of the worst food insecurity situations in decades. It is estimated that more than 46 million people are in Integrated Food Security Phase Classification (IPC) Phase 3 or above.

The sub-region is home to a large pastoralist population with significant vulnerabilities. Currently, the region, which includes Djibouti, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda is experiencing rising food insecurity due to extreme climate events such as drought and flooding, as well as conflict, socio-economic impacts of the COVID-19 pandemic, and volatile food and fuel prices, all of which are contributing to the creation of a huge humanitarian crisis. Regardless of future rainfall performance, the recovery period from a drought this severe will take years, with extremely high humanitarian needs even set to increase in 2023.

As malnutrition increases both the likelihood of falling sick and the severity of disease1, a food crisis is therefore a health crisis. In addition, sick people become more easily sick. Many people must choose between food and health care, with serious implications both for conditions that need long-term treatments, such as tuberculosis (TB) or human immunodeficiency virus (HIV) and non-communicable disease, but also for routine preventive health care services – including for reproductive, maternal and child health – with grave consequences. Disruptions in access to health care can further increase morbidity and mortality, as fragile livelihoods force communities to modify their health-seeking behavior and prioritize access to immediate life-saving assets such as food and water. In addition, displacement often further interrupts utilization of health care services, including preventive services like vaccinations.

More than 46 million people across the region are estimated to be in a ‘crisis’ situation (IPC 3 or worse), within which approximately 275 000 people across Somalia and South Sudan are experiencing a ‘catastrophe’ (IPC phase 5) situation.

In areas affected by food insecurity, outbreaks of communicable diseases are a major public health concern, particularly against a backdrop of often low immunization rates (exacerbated by the COVID-19 pandemic), insufficient health service coverage and the devastating combination of malnutrition and disease. Pregnant and lactating women, newborns, children, the elderly, and people living with chronic diseases such as tuberculosis (TB) and human immunodeficiency virus (HIV), are particularly vulnerable.

While finding food and safe water is a priority, health considerations are essential to avert preventable disease and death. Lastly, the region is largely affected by the continued upsurge of outbreaks of infectious diseases, including cholera, measles, yellow fever, mpox, hepatitis E, dengue, malaria and Sudan Virus disease (SUVD) Ebolavirus disease, which WHO considers to be a major concern. Extreme weather events, massive displacement, food insecurity and malnutrition, limited access to health care and low immunization rates all contribute to an increasing risk of disease outbreaks.

Based on WUENIC (WHO/UNICEF) estimates for the last three years, the routine immunization coverage has been below the expected target, especially in Djibouti, Ethiopia, Somalia, and South Sudan, as a result of conflict, the COVID-19 pandemic, and displacement, fueling the risk of disease outbreaks, which are already a public health concern in areas affected by drought and flooding. Additionally, large-scale displacement may hamper surveillance for epidemic-prone diseases, as well as routine immunizations, further worsening the situation. These health risks clash with an already fragile health system.