Habibou Iba’s twin sons are wasting away at the age of seven months after existing on a diet of millet and water.

The family was forced out of their home in January when their village in northern Burkina Faso was attacked as jihadist and ethnic violence escalated in the West African nation.

Aid agencies have distributed the typical rations of dry cereals, oil and beans, but what the children really need is milk, said Iba who is too weak to breastfeed.

“I am forced to beg in the village to buy them powdered milk,” Iba, 27, said by phone from the town of Dori, where her sons are being treated for malnutrition by the medical charity Medecins du Monde.

Although awareness about malnutrition has increased in the last few decades, aid agencies still struggle to provide a balanced diet in poor, remote places, said several nutrition advisors for international charities.

With U.N. figures showing wars, persecution and other violence have driven a record 68.5 million people from their homes, more people than ever are dependent on food aid – and for longer periods, making it critical for rations to be nutritious.

In West Africa’s Sahel region, which includes northern Burkina Faso, climate change and conflict have kept people in displacement camps for years with no end in sight. Mali has been in crisis since 2012, while Nigeria has been battling the Boko Haram insurgency for a decade.

“Historically, the concern has been about providing enough food in the context of emergencies, and this idea that an emergency is a short-term thing,” said Corinna Hawkes, director of the Centre for Food Policy at City University of London.

“But the modern-day crises are not short-term. There’s no question that the current world of food aid is not fully caught up with that modern reality.”

U.N. figures show that the number of people in the world without enough nutritious food has been rising since 2014, reaching 821 million in 2017 compared to 784 million three years earlier. The vast majority live in Africa.

Poor diet has overtaken smoking as the world’s biggest killer, according to the latest Global Burden of Disease study, causing 20 percent of deaths in 2017.



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