Afghanistan

Cluster needs

For five consecutive years, nearly three million children under five have been affected by acute malnutrition annually. This includes 3.1 million in 2021, 3.9 million in 2022, 3.2 million in 2023 and 2.9 million in 2024. In 2025, this number is expected to increase significantly, rising from 2.9 million in 2024 to 3.5 million with 867,308 children suffering from Severe Acute Malnutrition (SAM) and 2,589,174 children affected by Moderate Acute Malnutrition (MAM). Similarly, maternal malnutrition has remained a persistent issue with nearly one million acutely malnourished pregnant and breastfeeding women (PBW) each year; 804,365 in 2023 and 1,098,608 in 2024. In 2025, an estimated 1,159,346 PBW are expected to suffer from acute malnutrition. Helmand and Kabul provinces carry the highest burden of malnutrition in the country, each accounting for approximately 11 per cent of the total cases. In addition to these two provinces, Herat, Kandahar and Nangarhar collectively contribute to nearly 42 per cent of the overall caseload of malnutrition in the country.

According to the 2024 Integrated Food Security Phase Classification: Acute Malnutrition (IPC AMN) analysis, four provinces, Helmand, Kandahar, Nuristan and Paktika, are classified in Phase 4 (Critical). A total of 24 provinces are in Phase 3 (Serious) and the remaining 6 provinces (Baghlan, Bamyan, Blakh, Laghman, Samangan and Wardak) are in Phase 2 (Alert). Although Herat and Kabul are currently classified in Phase 3, they remain at high risk of slipping to Phase 4 without immediate improvements in food security as well as health, nutrition and water, sanitation, and hygiene (WASH) services. When comparing the 2024 IPC AMN analysis with the 2022 IPC AMN analysis, a total of 10 provinces deteriorated by one phase in 2024 compared to 2022. Seven provinces deteriorated from Phase 2 to 3: Daykundi, Herat, Khost, Kunduz, Paktya, Sar-e-Pul and Takhar. Additionally, Helmand, Kandahar and Nuristan deteriorated from Phase 3 to 4. Paktika remained in Phase 4. The analysis indicates that malnutrition remains widespread and severe in many parts of Afghanistan. The upcoming winter and rainy season (November 2024 to April 2025) is expected to exacerbate acute malnutrition due to increased risks of infectious disease outbreaks, reduced economic activities, limited agricultural output, restricted access to health and nutrition services caused by adverse weather conditions and the potential influx of returnees and deportees from neighbouring countries which may stretch the already limited health and nutrition services.

According to the 2024 IPC AMN report, acute malnutrition in Afghanistan is driven by multiple risk factors. These include inadequate quantity and poor quality of children's diets, suboptimal breastfeeding and caring practices, high disease prevalence (such as diarrhoea, malaria, acute respiratory infections (ARIs) and measles outbreaks), and insufficient immunization coverage. Poor WASH conditions, including limited access to safe drinking water and sanitation, further exacerbate the nutrition situation. Additionally, reduced access to health and nutrition services, high food insecurity and insufficient access to food contribute to worsening malnutrition levels. Broader shocks, such as drought, flooding and population displacement also significantly impact the nutritional status of affected populations.

Inadequate dietary consumption is a primary contributor to malnutrition in Afghanistan, with only 6.8 per cent of children meeting the Minimum Acceptable Diet, only 14.8 per cent consuming five or more food groups, and only 34.2 per cent receiving a sufficient number of meals per day¹, reflecting significant nutritional gaps across provinces. This lack of dietary diversity increases the risk of micronutrient deficiencies, impacting both physical and cognitive development in children.

Disease outbreaks further exacerbate the malnutrition situation, with over 60 per cent of children affected by illnesses like diarrhoea, malaria and ARIs². There is limited access to safe drinking water, with WASH services observed in various provinces. Only 46 per cent of households report sufficient water access, while 15 provinces report that fewer than 60 per cent of households have access to improved sanitation facilities. These deficiencies in WASH infrastructure are further compounded by poor hygiene practices, as only 42 per cent of households use soap for handwashing. These gaps contribute to ongoing health risks, particularly the high prevalence of diarrhoea.

Recurrent diarrhoea affects 64 per cent of children under five³, with provincial peaks as high as 92 per cent in Takhar. A surge in Acute Watery Diarrheal (AWD) cases continues to be reported in most provinces with more than 155,000 cases across 398 districts from January to October 2024. Inadequate WASH conditions facilitate the ingestion of fecal pathogens, which lead to diarrhoea, and intestinal worms and inhibit a child’s ability to absorb nutrients. A child with SAM is nine times more likely to die from common infections (e.g. malaria, pneumonia, diarrhoea)⁴. Additionally, 50 per cent of undernutrition cases are linked to recurrent diarrhoea episodes. Evidence indicates that half of all diarrhoea cases and a third of respiratory infections could be prevented through breastfeeding.

In 2024, measles vaccination coverage remained suboptimal, with only 72 per cent coverage nationwide and coverage below 80 per cent in up to 27 provinces. This has led to outbreaks in all 34 provinces, resulting in an 182 per cent increase in cases compared to 2023. From January to November 2024, 52,009 suspected measles cases were reported, including 7,020 confirmed cases. More than 50 per cent of confirmed cases among children under five were concentrated in Baghlan, Balkh, Kabul, Kandahar and Nangarhar. These outbreaks not only increase morbidity but also further deteriorate child nutrition.

Moreover, in 2024, the number of Mobile Health and Nutrition Teams (MHNTs) has decreased by 52 per cent compared to 2023, severely impacting access to essential health and nutrition services in hard-to-reach areas. Restrictions on community-based health services, especially those affecting women and female health workers, have further exacerbated malnutrition by obstructing the delivery of critical health and nutrition services. Additionally, over 450 nutrition sites have closed, disrupting access to vital services for thousands of malnourished children and pregnant or breastfeeding women.

The IPC Acute Food Insecurity (IPC AFI) assessment conducted in October 2024 indicates that high food insecurity leaves 11.6 million people facing Serious and Critical food insecurity with projections showing this number will rise to 14.8 million between November 2024 and March 2025. According to the 2024 IPC AFI projections, Herat, Nuristan, and Paktika have at least 35 per cent of their population in IPC AFI 3+. In Kabul and Herat, the number of people projected to be in IPC AFI 3+ is 1.22 million and 1.76 million, respectively. The IPC AMN results also indicated that Blanket Supplementary Feeding Programme (BSFP) coverage was reduced by 50 per cent nationally from January to August 2024 with reductions ranging from 30 per cent in Badakhshan to 85 per cent in Khost province and limiting preventive nutrition interventions in high-risk areas and further exacerbating acute malnutrition among children under five and PBW.

Response strategy

Cluster response plan

In 2025, the Nutrition Cluster aims to provide life-saving preventive and curative services to 5.98 million children under five and PBW across all provinces. To address the increased burden of acute malnutrition, the Cluster will enhance access to and utilization of high-quality preventive and curative interventions, targeting the most vulnerable groups, children under five and Pregnant and Lactating Women (PLW). This will include a comprehensive and cost-effective package of interventions delivered primarily through static health facilities, complemented by Family Health Houses (FHHs) and MHNTs in specific circumstances, in alignment with the national FHH guideline and MHNT rationalization plan. The 2025 Nutrition Cluster categories include:

1. treatment of children under five with SAM without complications;
2. treatment of children under five with SAM with complications;
3. treatment of children under five with MAM;
4. treatment of PBWs with acute malnutrition;
5. BSFP for children;
6. BSFP for PBWs and
7. Maternal, Infant and Young Child Nutrition (MIYCN) to primary caregivers of children aged 0-23 months.

Recognizing the gaps in treatment services identified in 2024, the Nutrition Cluster aims to strengthen and scale up the early detection, referral and treatment of acute malnutrition among children and PLW. To achieve this, the Cluster is prioritizing continued efforts in the integration of acute malnutrition management into the health system. The first step involves mapping health facilities and districts with low nutrition service coverage. These findings will inform the development and implementation of a rationalization plan to ensure comprehensive integration and scale-up of nutrition services. To enhance access to inpatient nutrition treatment facilities, the Nutrition Cluster will aim to implement at scale a cash allowance program initiated in 2023. This initiative will compensate mothers and mahrams for transportation and accommodation costs incurred when accessing treatment. These activities will be supported by community outreach and sensitization under the Integrated Management of Acute Malnutrition (IMAM) program to promote awareness and participation in increased nutrition service delivery.

The treatment services will be complemented by preventive measures to break the cycle of malnutrition. MIYCN counselling, with a focus on the critical 1,000-day window of opportunity, will emphasize exclusive breastfeeding for children aged 0–6 months and promote a well-balanced, diverse and nutritious diet for children aged 6-23 months. Additionally, the BSFP will be scaled up targeting children under five and PBW in IPC AFI 3+ areas. To strengthen these efforts, Nutrition Cluster partners will collaborate with Basic Human Needs (BHN) partners to implement community-level nutrition activities. These activities include early detection and referral services, vitamin A supplementation and the distribution of micronutrient powders for children aged 6-59 months. Additionally, PLW will receive targeted micronutrient supplementation.

To address the underlying causes of malnutrition, the Nutrition Cluster will work closely with the health, food security and WASH clusters to deliver a nutrition-sensitive integrated package of community and facility-based services for improved nutrition outcomes in prioritized districts. The Global Clusters call to action on integration strengthens inter-sector collaboration and partnerships in emergency settings. In alignment with the national strategy for Health Emergency Response (HER), the Nutrition Cluster is collaborating with the Health Cluster to enhance the integration of acute malnutrition management into the health system. This effort includes a systematic screening for acute malnutrition in children aged 6-59 months and pregnant and breastfeeding women attending health facilities for both curative and preventive services, ensuring timely referral for nutrition treatment as needed.

Additionally, in collaboration with the WASH Cluster, the provision of WASH kits will target vulnerable households, particularly those with children aged 6 to 59 months suffering from SAM attending nutrition sites. These kits will be distributed for beneficiaries to use to improve hygiene practices, supported by the orientation of frontline nutrition staff on effective household water treatment and hygiene promotion, ensuring better hygiene messaging to affected communities. Moreover, through continued collaboration with the Food Security and Agriculture Cluster (FSAC), the BSFP will be delivered through General Food Distribution (GFD) platforms, ensuring that all beneficiaries receive both food assistance and essential nutrition messaging. The integrated nutrition messaging package, which will be jointly developed with FSAC will be rolled out to maximize its impact and reach. Additionally, the Nutrition Cluster will advocate with the FSAC to include nutrition as a criterion in the selection of areas for GFD. Efforts will be made to screen and refer children and PLW for acute malnutrition during the BSFP distribution. These interventions reflect the Nutrition Cluster’s commitment to delivering a multi-sectoral response that prevents malnutrition and addresses the immediate needs of the most vulnerable populations. Efforts to enhance gender-responsive programming will include linking girls and women attending nutrition sites to Gender-Based Violence (GBV) services and training staff for GBV referrals.

Additionally, the recently launched UNICEF-WFP strategy on addressing wasting offers a significant opportunity for Afghanistan, which is one of the 15 countries with a high burden of acute malnutrition. In 2025, the Nutrition Cluster and UN agencies will lead efforts to place more focus on children with high-risk moderate acute malnutrition.

Targeting and prioritization

Failing to address the nutritional needs of vulnerable populations in Afghanistan could lead to a significant increase in child mortality rates. Malnutrition continues to be a leading cause of death among children under the age of five. Nearly half of deaths among children under 5 years of age are linked to undernutrition⁵. Children suffering from SAM are at a twelvefold increased risk of death, while those with MAM face a threefold increased risk compared to well-nourished children. Given that no other program in Afghanistan provides treatment for acute malnutrition, the Nutrition Cluster is targeting all provinces to deliver these critical services.

Key recommendations from a deep-dive analysis of treatment coverage conducted in June 2024 have provided guidance on scaling up nutrition treatment services, particularly scaling up through FHH, which are predominantly located in rural and underserved areas and expand nutrition services to non-HER service delivery points to increase access and coverage. Rationalizing the deployment of MHNTs is expected to play a crucial role in informing scale-up plans and advocacy efforts with the Ministry of Public Health (MoPH). Additionally, the reactivation of nutrition services in densely populated urban areas, such as Herat, Kabul and Nangahar, will be prioritized. Alongside ongoing advocacy to address challenges, including restrictions on community-level health and nutrition services and the requirement for women and female workers to have a Mmaharam, the Nutrition Cluster will explore innovative strategies to increase both access to and uptake of nutrition treatment services, especially among women and children.

Timely funding is essential for the successful scaling-up of nutrition services and the achievement of the targets set for the year. For these objectives to be fully realized, it is imperative that funds be released early in the year. The Nutrition Cluster will prioritize services and geographic areas based on the 2024 IPC AMN analysis and progress will largely depend on the amount and timing of funding made available to partners. Delays in funding or insufficient resources will directly impact the ability to meet the needs of vulnerable populations, meaning fewer women and children will receive the services they require by the end of the year.