Afghanistan

Summary of needs

The 2025 IPC Acute Malnutrition (AMN) projects 3.7 million children with acute malnutrition – 942,000 SAM, 707,400 with High-Risk Moderate Acute Malnutrition (MAM) and 2 million with MAM – in addition to 1.2 million PBW, with 77 per cent of the burden concentrated in 15 provinces.¹ Nutrition severity has more than doubled with nine provinces now in IPC AMN Phase 4 compared to four in 2025.² One in two children is stunted³ and without urgent funding and multi-sectoral action, reduced service coverage, disease and displacement will worsen acute malnutrition. In 2025, funding cuts led to the closure of more than 300 nutrition sites, denying nearly 90,000 children under five and PBWs access to critical services.

Poor diets among young children remain the primary driver: 90 per cent (2.1 million) of children under two live in child food poverty, and 1.2 million consume only two food groups.⁴ Around 80 per cent of SAM and MAM cases occur in this age group.⁵ Disease exposure is high, with diarrhea reaching 80 per cent in some provinces, over 96,000 suspected measles cases in 2025 and measles coverage below 80 per cent in 24 provinces.⁶ Over 50 per cent of households lack sufficient water, rising to 75 per cent in the worst-affected areas.⁷

Maternal and early childhood vulnerability is deepening. In 2025, monthly admissions for acute malnutrition were 13 percent higher than in 2024, with the sharpest rise – nearly 29 percent – among PBW, and nearly 1.2 million PBWs are projected as acutely malnourished.⁸ Only 27 per cent of pregnant women receive four or more ANC visits.⁹ Adolescent girls face severe risks: 60 per cent have iron-deficiency anaemia, and 1 in 4 are married before 18, heightening nutritional and early-pregnancy vulnerabilities.¹⁰

Response strategy

The 2026 Nutrition Cluster plan aims to provide preventive and curative nutrition services to 5.7 million children under five and pregnant and breastfeeding women across 27 provinces with high malnutrition rates. The response includes life-saving treatment and preventive services in nutrition severity 3 and 4 areas. Preventive and nutrition-sensitive programming will complement treatment services to break the cycle of malnutrition, in close collaboration with BHN partners. In 2026, the Nutrition Cluster will continue to strengthen linkages between humanitarian and development nutrition actors to support integrated, holistic approaches that deliver improved nutrition outcomes.

Treatment of Acute Malnutrition:

Treatment will cover Severe Acute Malnutrition (SAM) with and without complications, High-Risk Moderate Acute Malnutrition (MAM), and Early MAM in children aged 6–59 months, following updated national treatment protocols. High-Risk MAM will receive RUTF, while Early MAM will receive RUSF. Access will be enhanced through static health facilities, Family Health Houses (FHH), and Mobile Health and Nutrition Teams (MHNT), in line with national guidelines and the MHNT rationalization plan. Acutely malnourished pregnant and breastfeeding women and adolescent girls will be targeted. Treatment for acute malnutrition will be prioritized in nutrition severity 3 and 4 areas. The revised 2025 National IMAM guidelines and joint UNICEF–WFP prevention of wasting actions emphasize the importance of preventive interventions, while ensuring critical treatment where prevention fails. The joint plan also outlines the rationalization of nutrition treatment services across platforms to improve efficiency and leverage partners’ comparative advantages.

Management of At-risk Mothers and Infants under 6 Months (MAMI)

Infants under six months represent nearly 35% of admissions in stabilization centers, highlighting the growing nutritional needs of this vulnerable group. The MAMI approach integrates nutrition with health, social protection, and education systems, prioritizing the first 1,000 days, and strengthens local capacity and partnerships to ensure effective service delivery. Services will be delivered through facility- and community-based platforms and integrated with existing health, nutrition, and IYCF activities to strengthen continuity of care during emergencies. Special attention will be given to exclusive breastfeeding support and tailored interventions for both infants and mothers. Activities will include community screening, targeted counselling, maternal nutrition support, breastfeeding assistance, referral of high-risk infants to appropriate services, and follow-up to ensure safe growth and improved maternal wellbeing.

Maternal, Infant and Young Child Nutrition (MIYCN)

Maternal, Infant and Young Child Nutrition (MIYCN) counselling will protect and promote optimal infant and young child feeding practices, including early initiation and exclusive breastfeeding, appropriate complementary feeding, and continued breastfeeding up to 24 months and beyond. The role of nutrition counselors is critical in delivery of MIYCN messages and counseling. Deep dive findings of August 2025 noted the inadequate numbers of nutrition counselors throughout the nutrition service delivery platforms and significant low in the Stabilization centres. This cadre of staff remain critical as it also an exceptional platform practices for breastfeeding and complementary feeding.

Integrate Early Child Development (ECD)

Early Child Development (ECD) in Afghanistan focus on leveraging existing community platforms used for nutrition to promote stimulating care through grandmother networks, day care centres, home visits, and enhanced counselling and SBC. ECD counselling will be integrated into MICYN platforms, with child development monitoring conducted at facility level. Quality is ensured through capacity building of CHWs and nutrition counsellors, including ECD quality indicators in field monitoring. Additionally, an enabling environment is fostered through the development and simplification of ECD protocols, training modules, monitoring tools, evidence generation on ECD and nutrition outcomes, systematic education for frontline workers, and knowledge management, dissemination, and advocacy on nurturing care frameworks.

Blanket Supplementary Feeding Programme (BSFP)

BSFP will be implemented in high-risk areas to prevent the deterioration of nutritional status among children aged 6–23 months and pregnant and breastfeeding women (PBW). The programme provides a regular supply of specialized nutritious foods to reduce the incidence of acute malnutrition. BSFP for young children 6 – 23 months will target nutrition severity 3 and 4. While for pregnant and breastfeeding women and adolescent girls (pregnant and breastfeeding) in high food insecure areas (IPC AFI 3+) will also be targeted BSFP with Specialized formulated foods supplements.

Improving young Children Diets (In collaboration with BHN Actors)

Given that 80–85% of SAM and MAM cases occur in children under two, and the strong link between child food poverty and wasting/stunting, preventing malnutrition is impossible without improving diets during the first two years of life. In 2026, UNICEF and the Nutrition Cluster will therefore adopt an integrated multisectoral strategy that combines lifesaving treatment with stronger prevention efforts. The First Foods multisectoral approach, focused on improving diets for children aged 6–23 months through coordinated Nutrition, WASH, Food Security, Agriculture, Livelihoods and Social Protection actions, will continue under UNICEF, WFP and FAO, with scale-up planned in 2026. Guided by the First Foods Afghanistan Initiative, partners will place young children’s diets at the centre of coordinated action across food, health, WASH, agriculture, education and social protection systems. This will include strengthening local nutrition- and climate-smart food systems, expanding Baby WASH and One Health interventions, and scaling community-based nutrition education. Nutrition-linked cash assistance and shock-responsive mechanisms will help vulnerable households access diverse, nutritious foods for infants and young children. In parallel, women’s and youth skills development will support local first-foods production and processing, creating sustainable, community-driven solutions to reduce malnutrition.

Micronutrient Supplementation (In collaboration with BHN Actors)

Micronutrient supplementation will be scaled up to prevent and address deficiencies among nutritionally vulnerable groups; children aged 6–59 months, adolescent girls, and pregnant and lactating women (PLW). The intervention includes the provision of vitamin A and micronutrient powders for children 6 – 59 months, multiple micronutrient supplements (MMS) for PBWs, and weekly iron and folic acid supplementation for adolescent girls through community and school platforms. These actions aim to reduce anaemia, support healthy pregnancy outcomes, and strengthen immunity in young children. Supplementation will be delivered through static health facilities, FHHs, MHNTs and integrated community platforms, accompanied by targeted counselling to ensure adherence and safe use.

Maternal Nutrition (In Collaboration with BHN Actors)

A comprehensive package of interventions will target pregnant and breastfeeding women and adolescent girls with acute malnutrition in nutrition severity 3 and 4 areas. In collaboration with BHN actors the cluster will strengthen its focus on adolescent girls and maternal nutrition by supporting community- and school-based weekly iron and folic acid supplementation for adolescent girls and promoting multiple micronutrient supplements for pregnant and lactating women. Alongside supplementation, the Cluster will emphasize improving diet quality to prevent anaemia among adolescents grils and PBWs across all districts. Efforts will also include stronger integration of nutrition into antenatal care—through counselling, weight monitoring, and adolescent-friendly nutrition services—while engaging community networks to promote improved household nutrition practices. Current efforts to provide nutrition sensitive cash transfers to vulnerable PBWs in prioritized areas with nutrition challenges.

Multisectoral Actions and Collaboration

In 2025, the nutrition in collaboration with Health FSAC and WASH clusters initiated joint working approach aimed at increasing joint targeting, leveraging on partnerships to foster efficiency and strengthen localization with the goal of improving nutrition outcomes. Through high level humanitarian leadership a plan for a multisectoral strategy and a framework to guide the efforts for better foods security and nutrition in Afghanistan.

At community and service delivery platforms cluster will strengthened collaboration with Health, Food Security and WASH clusters will ensure integrated services of combining counselling, screening and referral with WASH NFI kits, hygiene promotion and nutrition screening through GFA and BSFP platforms to reduce disease exposure, improve diets and address the underlying drivers of acute malnutrition. WASH kits will specifically target vulnerable households with children 6-59 months attending nutrition sites and staff will be oriented on household water treatment and hygiene promotion. Collaboration with FSAC will ensure BSFP is delivered through General Food Distribution (GFD) platforms with integrated nutrition messaging and children and PBWs screened during GFD will be referred for treatment as needed. The Nutrition Cluster will advocate with FSAC to include nutrition criteria in GFD area selection.

The cluster will link children with SAM and MAM to immunization services. Girls and women attending nutrition sites will also be linked to immunization services when needed and gender-responsive programming will be strengthened by linking them to GBV services and training staff for GBV referrals. Health and nutrition staff will be targeted for GBV sensitization and training to facilitate referrals in coordination with the GBV AoR. The Nutrition Cluster will also engage with the PSEA Taskforce to train frontline health and nutrition workers on PSEA reporting mechanisms, equipping teams with the necessary tools and skills to identify, monitor and mitigate PSEA risks. Frontline workers will also receive training and support to raise community awareness on rights, complaint mechanisms and PSEA concerns, integrating awareness into community interventions and ensuring survivors are referred to and have access to unconditional assistance and technical support through GBV and child protection partners.

Targeting and prioritisation

The 2026 Nutrition Cluster plan aims to deliver preventive and curative services to 5.7 million children under five and PBW across 27 critical provinces.

Without timely action, acute malnutrition could escalate into a major humanitarian crisis. Children with SAM face a 12-fold higher risk of death,¹¹ while those with MAM face a threefold higher risk, underscoring the urgency of expanding treatment access.¹² As no other programme in Afghanistan provides treatment for acute malnutrition, cluster-led interventions remain essential for saving lives in all targeted provinces. To strengthen district level (granular) targeting, the Cluster will use 2025 evidence, including Mass Mid Upper Arm Circumference (MUAC) screening beyond case detection. The resulting data will be systematically analysed to inform district-level prioritisation, enabling partners to target high-risk areas, optimise resources and enhance operational impact. This evidence-driven approach will improve timely treatment and support more effective sub-national planning and decision-making. Timely, predictable funding is critical to achieving 2026 targets, with early disbursements allowing partners to align interventions with 2025 IPC Acute Malnutrition priorities. Insufficient or delayed funding will reduce the number of women and children reached, limiting access to life-saving services and increasing mortality risks. As the Cluster’s 2025 targets assume adequate donor support, any resource constraints will require prioritisation guided by Global Nutrition Cluster adaptations to ensure Acute Malnutrition services remain effective even under reduced funding.

Promoting accountable, quality and inclusive programming

Access to nutrition services for women and children remains constrained by gender and cultural barriers. To address this, all cluster activities - from awareness to life-saving preventive and treatment services - will be delivered by trained male and female frontline workers following national guidelines. Advocacy will support increased participation of female health workers, ensuring women’s privacy, dignity, and comfort. Accountability to Affected People will be strengthened through community engagement, mother-to-mother support groups, and community counsellors empowering women, adolescent girls, and caregivers with Maternal, Infant, and Young Child Nutrition (MIYCN) knowledge. The Cluster will explore ways to include children, women, and community voices in program design and delivery. To reach the most vulnerable, including children under five and PBWs, decentralised community-based service delivery will be prioritised. Community health workers will mobilise and sensitise populations to improve nutrition-seeking behaviours. Transparent information, feedback channels, Awaaz, and onsite complaint boxes will ensure voices are heard. Revised protection guidance and interventions will safeguard high-risk groups – including infants under six months, children with disabilities, orphans, IDPs and women without a mahram – while upholding safety, dignity, and Do No Harm principles.

Links to basic services and basic human needs (BHN) programmes

Preventive interventions are essential to addressing the persistently high levels of acute malnutrition in Afghanistan. Strengthening linkages with basic services and Basic Human Needs (BHN) actors remains critical at strategic, service delivery, and community levels. Many BHN actors are also Nutrition Cluster partners, providing a direct pathway for collaboration in planning, implementation, and comprehensive monitoring of the nutrition response.

To reinforce these linkages in 2026, several actions are planned: the Nutrition Cluster will coordinate humanitarian and BHN activities, ensure alignment of tools and principles, and establish operational thresholds to guide the prioritization of responses based on area-specific severity. Efforts will also focus on harmonizing data collection and reporting templates, aligning the accountability framework, and conducting joint monitoring of program implementation, coverage, and financing gaps. These measures aim to enhance the efficiency, coherence, and impact of the nutrition response across all levels.

Cost of Response

The Nutrition Cluster used established unit costs to estimate the overall resources required for nutrition interventions in the 2026 Humanitarian Needs and Response Plan. The costing methodology is grounded in standardized inputs and implementation modalities used across partners, ensuring comparability and reliability of estimated requirements. Comprehensive cost considerations for the nutrition response include the procurement, transportation, delivery and storage of ready-to-use specialized foods, essential medicines for treating acute malnutrition, as well as prevention of acute malnutrition through community-based preventative services, including Blanket Supplementary Feeding Programs and promotion, counselling on optimal maternal, infant and young child nutrition practices and operational, supervision and monitoring costs for quality program delivery.

In scaling up efforts, the Nutrition Cluster is leveraging existing platforms such as Fixed Health Facilities, Family Health Houses, Day Care Centres, joint Mobile Health and Nutrition Teams and Community-Based Vaccination Centers in collaboration with Health Cluster partners to enhance coverage for the treatment and prevention of acute malnutrition. More than 80% of health facilities currently offer co-located Outpatient Department SAM and MAM services which share human resources and operational costs, thereby enhancing overall cost efficiency. This co-location also reduces duplication of fixed operational expenses and supports streamlined supervision and reporting processes.

Changes in operating costs continue to be shaped by supply-chain dynamics, including transportation delays, increased fuel prices and higher logistics demands in hard-to-reach areas. The cluster also considers partner capacity, staff turnover and training needs, which influence both cost and implementation quality. Efforts to harmonize procurement and strengthen local storage capacity also contribute to cost stabilization.

The efficiency of nutrition interventions is driven by a strong focus on prevention and close integration with complementary sectors such as Health, Food Security and WASH. This strategic approach aims to reduce the number of cases requiring costly treatment for acute malnutrition. Additionally, the BSFP and General Food Assistance play a crucial role in improving access to diversified diets, preventing malnutrition and reducing the duration and severity of treatment needs. Preventative interventions implemented through BHN partners particularly micronutrient supplementation and SBCC programs further strengthen cost-effectiveness by reducing caseloads and demand on treatment services.
The cluster also prioritizes cost-effective delivery models such as integrating nutrition screening into polio vaccination campaigns.

Cluster Severity and PiN Calculation Methodology

The Afghanistan Nutrition cluster used an adjusted and technically accepted approach to estimate the number of people in need of nutrition assistance in 2026. The calculation involves several steps:

Prevalence of acute malnutrition:

To estimate the People in Need (PiN) for the Nutrition Cluster, the first critical step is to obtain updated prevalence figures for acute malnutrition among children under five and pregnant and breastfeeding women. To ensure the 2026 PiN estimation is as accurate as possible, the Nutrition Cluster used the most recent GAM-by-MUAC prevalence data from the August 2025 Community Nutrition Sentinel Surveillance (C-NSS) conducted across all 34 provinces

Population:

The second step is to obtain the population numbers. The most recent population projections issued by UNOCHA in September 2025 is used to calculate the total PiN for 2026. For the population of children aged 0 to 59 months, 18% of the total population is used and the number of pregnant and breastfeeding women (PBW) is estimated as 10.8% of the total population.

Incidence rate and correction factor:

The third step is to estimate the incidence rate. The incidence rate for acute malnutrition refers to the number of new cases occurring in a specific population over a given period, typically a year. A correction factor is used to adjust prevalence data to estimate incidence and providing a more accurate reflection of the true burden of malnutrition in the population. In Afghanistan, a correction factor of 2.6 is applied to account for the incidence of acute malnutrition as per the global guidance.

Calculation of caseloads for SAM and MAM children and PBW:

In Afghanistan, the caseload for 2026 is calculated by multiplying the number of children 6-59 months by the prevalence rate and then by the correction factor (Number of children 6-59 months × Prevalence Rate (cGAM)× Correction Factor). The Combined GAM (cGAM) is derived from adjusted approach using 2025 GAM by MUAC working through established relationship between GAM by GAM WHZ and GAM by MUAC (FEX 61 (ennonline.net). The caseload for malnourished pregnant and breastfeeding women is estimated by multiplying the prevalence rate of malnourished PBW by the number of PBW (PBW Population × Prevalence Rate) in accordance with global guidelines.

Calculation of caseload for Mother and Infant Young child Feeding (MIYCN) and Blanket Supplementary Feeding Program (BSFP):

In Afghanistan, 6.8% of the total PBWs population is used to estimate the caseload for MIYCN (Maternal, Infant and Young Child Nutrition) interventions, while the caseload for BSFP (Blanket Supplementary Feeding Program) is estimated from children 6-23 months and PBW populations in IPC AFI Phase 3 or higher locations.

Total PIN calculation formula:

The following formula is used for the total PIN calculation of the nutrition cluster.

MAX (SAM Children+ MAM children, BSFP children) + MAX (MAM PBW+MIYCN, BSFP PBW)

Needs Analysis, Response Monitoring Strategy and Data Gaps

The Nutrition Cluster will continuously monitor needs and the overall response using routine data generated through the Nutrition Information System (NIS), DHIS2 and other information sources, including assessments conducted through various platforms and field visits. Monitoring efforts will focus on ensuring timely identification of needs, tracking service availability and guiding partners toward evidence-based decision-making.

Use of the Nutrition Information System and other data sources will include:

• Monthly nutrition response monitoring: Monthly analysis of admission trends, treatment coverage and progress toward annual targets and the PIN. As part of the rationalization plan to ensure optimal and equitable geographic coverage, the Nutrition Cluster will also monitor the distribution and functionality of nutrition service delivery sites.

• Community Nutrition Sentinel Site Surveillance: The community-based surveillance system routinely collects and analyses child nutrition data to detect trends and guide timely responses. Supported by UNICEF and the EU, the CNSS gathers quarterly, validated information from 451 sentinel sites across all 34 provinces, measuring over 18,700 children under five each round. The system provides essential evidence for humanitarian planning, policy decisions, and accountability, ensuring early warning and informed action in the country’s evolving nutrition context.

• Regular mass MUAC screenings: Cluster partners will conduct routine mass MUAC screenings to monitor the nutritional status of children, identify cases of acute malnutrition and estimate treatment program coverage. Additionally the systematic analysis of the mass MUAC screening data would provide citocal information for targeting at districts levels.

• Nutrition Early Warning and Early Action System: The EW-EA system anticipates and responds to acute malnutrition risks across Afghanistan, using IPC AMN identified risk factors and guided by the nutrition analytical framework. Established thresholds trigger early actions to identify emerging hotspots and populations at greatest risk. Continuous monitoring, reporting, and dissemination of EW-EA findings enable partners to implement timely, adaptive, and cost-effective nutrition interventions, mitigating shocks and preventing deterioration in nutritional status.

• Population-based data collection (SMART surveys): Targeted SMART nutrition surveys will be carried out in priority provinces to collect anthropometric data and other key indicators. These surveys will help determine the prevalence of acute malnutrition among children and women and identify underlying factors affecting nutritional outcomes.

• Field visits and on-site monitoring: Regular spot checks, supervision visits and field monitoring will be conducted to assess program implementation quality, validate reported data and engage with communities and local stakeholders to identify evolving needs.

In addition, the Nutrition Cluster will coordinate closely with other clusters and partners including REACH to conduct joint assessments aimed at identifying the specific needs of returnees and communities affected by natural disasters.

Data Gaps

In 2026, Afghanistan will continue to face critical nutrition data gaps needed to understand the drivers of malnutrition. While the last National Nutrition Survey (2013), Multiple Indicator Cluster Survey (2023), and SMART Surveys (2022) provided important insights, these datasets are now largely outdated. Key information on child mortality, stunting, infant and young child nutrition indicators (EBF, MDD, MMF), maternal malnutrition, and micronutrient deficiencies—particularly vitamin A deficiency and anaemia among children under five, women, and adolescent girls—remains largely missing. Filling these gaps is essential for evidence-based planning, effective targeting of interventions, and monitoring progress toward reducing malnutrition nationwide.