Rarely is the relationship between cost and benefit as clear as it was last Friday, when Stephen O’Brien, the United Nations undersecretary general for humanitarian affairs, warned the U.N. Security Council that the world is facing its greatest humanitarian crisis since 1945. More than 20 million people in four countries in Africa and the Middle East are at risk and without collective action, “they will simply starve to death.” The price tag to save those lives? Just $4.4 billion by July.

The four countries O’Brien identified are Yemen, South Sudan, Somalia and Nigeria. In each case, the cause of the crisis is the same: conflict. In other words, these crises are man-made. Worse, warning signs were evident months ago and the worst of these crises could have been averted.

In Yemen, two-thirds of the population — 18.8 million people — need aid and more than 7 million others are hungry. Those numbers have grown by 3 million in the two months since the start of the year. The roots of this horrific tragedy lie in the proxy war fought by the government — supported by Saudi Arabia and other Sunni states in the region — and Houthi rebels backed by Iran. All parties to the conflict have promised to let aid to civilians go through, but those words have proven empty as military leaders instead deny access to humanitarian aid or use it for their own purposes.

In Somalia, it is reckoned that more half the population, 6.2 million people, face acute food shortages; 2.9 million are at risk of famine and need immediate assistance to save their lives. Nearly 1 million children under the age of 5 will be “acutely malnourished,” warned O’Brien. The country’s prime minister, Hassan Ali Kayre, said that 110 people died of hunger in a single region over a two-day period. The situation in Somalia is especially troubling as the country suffered through a famine just six years ago that killed 250,000 people.

In South Sudan, the world’s youngest country, a civil war that has raged for three years has rendered 42 percent of the population “food insecure.” O’Brien estimates that more than 7.5 million people need aid, an increase of 1.4 million from last year. More than 1 million children are thought to be acutely malnourished throughout the country; more than one-quarter of them could die soon as a result. The dire food shortage is compounded by a cholera epidemic that began in June 2016 and continues to spread across the country.

Finally, the savagery of the Boko Haram guerrilla group has reduced the northeastern part of Nigeria to near ruin. The seven-year uprising has killed more than 20,000 people and displaced 2.6 million others. The malnutrition is reported to be so severe that the affected are too weak to walk to food and some communities have lost all their young to starvation.

These numbers are horrific — if not numbing — but it is vitally important to recognize that they are not used loosely. When humanitarian officials and aid groups talk about “famine” they mean something quite specific: Famine occurs when more than 30 percent of children under the age of 5 suffer from acute malnutrition and mortality rates are two or more deaths per 10,000 people every day, among other criteria. The U.N. estimates that 1.4 million children are already at risk of imminent death in those four countries, and those numbers grow larger each day as hunger creates weakness and renders victims more susceptible to other diseases that accompany conflict and displacement.

Moreover, the effects of childhood hunger are often permanent. Growth is stunted, learning slowed, and educational and economic opportunities are lost. Generations are damaged and entire communities and societies unraveled. Children that grow up knowing only war and hunger often aspire to nothing more. Their “normal” is anything but.

The U.N.’s O’Brien reported that the price of averting this grim situation is $4.4 billion. That is just part of the $5.6 billion that the U.N. has estimated is needed to tackle urgent humanitarian needs worldwide; it is estimated that less than 2 percent of that amount has been pledged. And even money that has been promised is slow to arrive: O’Brien warned that $2.1 billion is needed for Yemen, but only 6 percent has been received thus far. In April, U.N. Secretary-General Antonio Guterres will chair a pledging conference for Yemen.

Last month, Japan approved $22.4 million in humanitarian and reconstruction assistance in South Sudan, pushing its total aid to the country $189 million since December 2013. Foreign Minister Fumio Kishida on Sunday indicated that the government will consider additional $6 million in aid to response to the famine in the country. Tokyo in addition pledged $50 million in aid for northeast Nigeria. Last week, the Japanese government promised $13 million to aid the World Food Program in Yemen.

While every dollar and yen helps, the scale of the looming catastrophe is likely to swamp these efforts. The world must launch a systematic program to help these groups. The problem is that world leaders have long recognized that need and annually announced — at Group of Seven, Group of Eight and U.N. gatherings — their intention to do more. And each year the problem seems to get worse. Aid alone is not the answer; governments and leaders must be held responsible for creating the conditions that allows famine to occur. Only then is there even a chance to end the cycle of suffering.

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