Haley Swartz is a Research Program Coordinator for the Johns Hopkins University, working with the Global Food Ethics and Policy Program. Haley researches food assistance programs and nutrition governance in developing and low- and middle-income countries with Professor Jessica Fanzo, Bloomberg Distinguished Associate Professor of Ethics & Global Food and Agriculture at SAIS. Haley holds a Master of Public Policy and a Bachelor of Arts in Women’s Studies and Government, both from the University of Virginia.

The operational and technological complexities of distributing food to nutritionally vulnerable civilians in conflict-induced humanitarian crises are most clearly apparent in South Sudan, and particularly in the ongoing famine declared in February 2017 (WFP 2016). Instability, conflict, and violence pose significant risks to humanitarian and relief organizations, the food supplies they procure, and prospects for the rehabilitation of domestic agriculture and local crops (Quinn 2010). This article will examine why organizations such as the Red Cross, US Agency for International Development (USAID), and the World Food Programme (WFP) have been stymied in the delivery of food to hungry populations in South Sudan despite advancements in both cost- and nutritionally-effective food assistance technology such as cash and voucher (CV) programs. Obstruction of relief activities by the government and violent retaliation against humanitarian workers by opposition forces ultimately inhibit food delivery in the context of a fatal famine.

In the wake of a two-year drought throughout East Africa, an estimated 5.5 million South Sudanese people, approximately 47% of the country’s population, will experience acute food insecurity, starvation, and high levels of excess mortality through the peak lean season in July 2017 (European Commission 2017). On February 20, 2017, the Integrated Phase Classification (IPC) of the Famine Early Warning System declared a famine (Phase 5) in two of South Sudan’s counties, the first declaration of its kind since Somalia’s 2011 famine (USAID 2017). The IPC projects food insecurity will worsen by May 2017 throughout the country, as shown in Figure I (Integrated Food Security Phase Classification 2017).

Figure I

In the midst of violent clashes between the government of South Sudan and the Sudan People’s Liberation Movement-in-Opposition, the WFP and its partners have provided health care, nutrient supplementation, and food aid to 1.9 million internally displaced persons (IDPs) and 1.6 million refugees, the majority of whom are malnourished and thus susceptible to chronic, acute, and potentially fatal diseases (USAID 2017). The most nutritionally vulnerable groups – approximately 80% of the country’s population – live in rural South Sudan and are unreachable by foot or car. Ongoing conflict has destroyed local crops, including sorghum, maize, millet, and rice grown by primarily subsistence farmers, while the unpredictability of the El Niño droughts and floods significantly reduce crop yields. As a result, the viability of local agriculture has been limited, for both trade and household consumption (African Development Bank Group, 2013). Without farming and other livelihood activities to support crop cultivation, many individuals report they primarily subsist on water lilies (USAID 2017).

Food Aid Provides Calories, Not Nutrients

In its 2008 strategic plan, the WFP declared an institutional shift from a model of food aid to one of food assistance to improve nutrition and reduce hunger in low and middle income countries (LMICs) (WFP 2010). Food aid reflects in-kind rations of basic commodities to hungry communities in bulk, including crops such as maize and other nutrient-fortified foods such as corn-soya blend (WFP 2012). Such aid has traditionally been delivered by air, by boat, or by foot to those vulnerable groups on the brink of starvation in resource-poor and conflict-ridden areas (UNICEF 2016).

While food aid increases food supply, food assistance provides indirect access to food by supplementing household income through cash and voucher (CV) programs. Households receive money to purchase food through paper vouchers, physical cash, or electronic disbursement via SIM cards, e-money, or prepaid cards. Food assistance requires fully operational markets and an economic, social, and cultural context in which consumers are able to buy and sell locally-produced foods.

CV programs offer nutritional benefits that food aid rarely can provide due to the exchange of foods and food groups naturally occurring within a marketplace. Food assistance enhances an important component of nutrition status, or dietary diversity, the variety of foods and nutrient-rich food groups available for consistent consumption. Food assistance instruments, including CVs and the local and regional procurement (LRP) of foods, effectively address the underlying and basic causes of malnutrition primarily due to their flexibility in both implementation and distribution within varying economic and agricultural contexts throughout the world (Lentz et al. 2013). Food aid, on the other hand, tends to address only acute instances of hunger, distributing nutrient-poor foods such as cereals and ready-to-eat supplementary foods that are easily transportable, produced in bulk, and will not spoil quickly. In sum, food aid provides calories, while food assistance provides nutrients.  

Food Assistance is Cost-Effective, but Infeasible in Conflict

Following a February 2017 incident in which an armed militia looted Save the Children’s warehouse in northern Jonglei, the only distributor of food aid in the area (Lynch 2017), the WFP helped negotiate the opening of a “humanitarian corridor” connecting Sudan to South Sudan to facilitate in-kind food delivery (Craig 2017). The WFP hopes to transport 2,000 metric tons weekly into Unity, a South Sudanese state in the midst of famine, prior to the start of the lean season (Sudan Tribune 2017).

In most development contexts, research indicates food aid is the least cost-effective modality (Hidrobo et al, 2014). A WFP cost-efficiency analysis found that the cost per beneficiary of in-kind food aid compared to vouchers were USD $29.50 and $25.20, respectively (WFP 2014). While food aid merely supplements food supply, food assistance can simultaneously improve nutrition, stimulate developing economies, encourage local food production, and reduce operational costs for on-the-ground relief organizations (WFP 2010). Little research has examined the comparative cost-efficiency of food aid and CV programs in acute famines due to the urgency of the situation and the impracticality of program implementation. Moreover, due to insecurity in conflict-ridden regions like South Sudan, most food is still distributed through traditional methods of aid.

In revising its 2017 budget for the Emergency Operation in South Sudan, the WFP increased the budget for food and related costs by USD $20 million. This revision requested no change in CV program funding (WFP n.d.). When divided by modality, 93% of the WFP’s emergency budget provides in-kind food aid, while only 7% provides food assistance in the form of CVs (see Figure II).

Similarly, USAID’s Food for Peace Program allocated USD $528.3 million to South Sudan for food aid in the 2017 fiscal year, with two-thirds of funding providing in-kind food aid and one-third to LRP (USAID 2017). Only 1% was reserved for food cash transfers (see Figure III).

Barriers to the implementation of electronic and other innovative forms of innovative food assistance include violent retaliation against relief staff and government obstruction of humanitarian activities.

Since 2013, over 75 humanitarian workers have been killed working in South Sudan (European Commission 2017). A road ambush killed six relief staff – four of whom were Kenyan and two who were South Sudanese – on March 25, 2017 (TVCNews 2017). In recent months, food has reportedly become a weapon of war: rebels kidnapped eight staff members from Samaritan’s Purse, an American charity, in mid-March, demanding food aid deliveries as ransom (ENews Channel Africa 2017).

On several occasions since its independence from Sudan in 2011, government officials in South Sudan have actively sought to block UN peacekeeping operations and humanitarian assistance from entering the country, including critical deliveries of food aid (Lynch 2017).  Moreover, once in the country, foreigners may face retaliation from both sides of the conflict: in December 2016, the government deported Justin Lynch, an Associated Press reporter who broke several stories related to government obstruction of humanitarian activities throughout the 3-year conflict (Chang 2016).

Valuing Nutrition During Violence

Prior to the 2017 famine, the African Development Bank Group (2013) classified the agroeconomy of South Sudan as a low-input, low-output subsistence agriculture rather than production for market exchange. South Sudan could thus qualify as a promising target for technological investment and food assistance programs that would promote dietary diversity and economic development while reducing malnutrition and poverty. However, the current context – political strife, violence, and famine – prohibit any such investments indefinitely.

The WFP describes transfer modalities as a “choice,” listing CVs and in-kind food aid as “modes for distributing resources [which are] a means, not an end” (WFP 2014). While this may be true for LMICs with stable political systems and moderate rates of malnutrition, South Sudan illustrates the complexities inherent to the delivery of food within violent political contexts and emergency famines. Planes that drop food aid to hungry populations in conflict-areas are described as a “short term measure” primarily to avoid death by starvation within several weeks or months (International Committee of the Red Cross 2017). Though necessary in certain contexts, such a system is unsustainable; it is both cost and nutritionally inefficient. However, implementing cost-effective, evidence-based cash and voucher programs to millions of nutritionally-vulnerable people requires domestic stability, peace, and political will. In emergency contexts, such as the South Sudan famine, humanitarian organizations will only be able to deliver food to hungry populations using traditional methods until governments prioritize hunger over politics.


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PHOTO CREDIT: "Delivering food aid in Ulang, South Sudan" by Alexandr Podolian from Wikimedia Commons is licensed under CC BY-SA 4.0.