Yemen + 16 more

Casualties of conflict: 7 urgent humanitarian crises, The 2020 Early Warning Forecast, a publication of Lutheran World Relief and IMA World Health

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The humanitarian outlook for 2020 and beyond forecasts a situation that is both complex and insecure, even as global development gains bring millions out of extreme poverty.

The causes and conditions of extreme poverty are rarely limited to a single factor. Rather, the world’s most vulnerable people live in a complex context, often in fragile or failing states, where political and social systems that might offer protection have broken down.

And increasingly, the common underlying denominator is violent conflict. The nature of modern conflict is also becoming more complex. There are fewer formal wars between states, but an increasing number of longer-lasting internal conflicts within countries that impact entire regions. Combatants are increasingly non-state actors, including local militias, guerrilla movements or terrorist organizations. Violence is at times fueled by outside powers in proxy wars. Fighting is being sustained by war economies, that include trafficking in minerals, people and/or illicit goods, as well as by diaspora contributions. Increasingly, the traditional international rules of war and humanitarian protection are being flouted.

A recent United Nations report underscores these multiple drivers of humanitarian crisis. Among its findings:

  • Armed conflict has driven a record 71 million people from their homes. More than half of the 50 countries with the most new displacements were affected by both conflict and natural disaster.
  • Eight of the worst food crises in the world are linked to both conflict and climate shocks.
  • Hunger is rising, and it too is driven largely by conflict. Two-thirds of the 74 million people suffering from acute hunger in the world live in 21 countries and territories affected by conflict and insecurity.

This presents a host of challenges for nongovernmental organizations working to eliminate poverty and ease human suffering. We will need to employ new, imaginative and innovative approaches if we hope to make an impact. We are going to have to build ou**r c**apacity to work in conflict-ridden, hostile environments, because that’s where the extremely poor who most need assistance are going to be. With record numbers of refugees and the internally displaced fleeing from conflicts that are lasting longer, we will have to employ development approaches and longer-lasting solutions that include new partners, including the private sector. And it will be vital to recognize the primacy of local partners who best know the social and political context of their communities.

This Early Warning Forecast for 2020 highlights seven continuing or worsening complex humanitarian emergencies that we believe will require urgent attention in the next year. This list is not comprehensive, but singles out those specific crises or issues that will have ripple effects well into the coming years.


Yemen, one of the world’s poorest countries, is in the midst of a humanitarian crisis widely considered to be the world’s worst.

The driving factor is a civil conflict that started in 2015 between the government and Houthi rebels, but which is widely regarded as a proxy war between Saudi Arabia and Iran and others. An aerial bombing campaign led by the Saudis has caused widespread destruction and civilian casualties.

Even before Yemen’s civil war started in 2015, half of its people lived below the poverty line. The U.S. reports that 24 million people, 80 percent of the country’s population, stand in need of humanitarian assistance. The war has killed over 100,000 people according to one estimate, destroyed Yemen’s infrastructure, and displaced over 4 million. Despite an agreement for a cease-fire around the critical port of Hodeida, little progress has been made to increase access to humanitarian assistance.

The conflict is taking a terrible toll on civilians, who are living in communities without basic services, access to health care, scarce food sources and poor sanitation, in addition to the continual threat of violence. It has become a blatant example of the violation of international humanitarian principles, with many instances where civilian populations and infrastructure, such as hospitals, have been targeted for aerial bombing. Humanitarian response has been impeded, and according to some, access to food has been used as a weapon of war.

Response: Lutheran World Relief and IMA World Health are working in the port city of Aden and a district to the north of Aden to improve the health of war-affected communities through projects focusing on waste management and rainwater collection to provide a clean and safe source of water.


After battling the world’s second largest Ebola epidemic on record for more than a year, health officials were hoping that the end was in sight.

The number of new cases had been steadily declining this fall. The progress in slowing the epidemic was due in part to contact tracing, a painstaking process in which health workers find every person an Ebola patient had contact with, vaccinate them with the newly approved Ebola vaccine, and visit them daily for 28 days to monitor their health and look for signs of infection.

In November, local militias stepped up attacks on civilians, and violent protests broke out against the UN presence, targeting both the UN peacekeeping operation and the international Ebola response. Protestors targeted health workers and attacked clinics that are responding to the Ebola crisis. In the midst of the renewed violence, two IMA World Health-supported clinics were attacked, and their Ebola isolation units burned to the ground. The unrest forced the UN and international NGOs to evacuate their staff, and the Ebola response was briefly interrupted. As a result, the number of new cases began rising again.

Clinics are operating and contact tracing continues. With continued determination and persistence by dedicated health care workers and the international community, this Ebola epidemic will hopefully be history in 2020. But the threat of violence could imperil this successful result.

Response: IMA World Health is working in the epicenter of the Ebola zone, coordinating with local government, organizations, and communities to stop the spread of the virus in 10 of the most-affected health zones in the North Kivu and Ituri provinces, where nearly 1.2 million people live. IMA World Health was well-positioned to respond to the epidemic, given its 20 year history building the capacity and resilience of the health care system in the Democratic Republic of Congo.


Central American countries have faced long stretches of drought over the last three years. In 2018, a delayed start to the rainy season ruined harvests for up to ** 70 percent of small-scale farmers in the Dry Corridor** that runs through Nicaragua, Honduras, El Salvador, and Guatemala.

Irregular rainfall is already estimated to have affected between 10 percent to 20 percent of coffee production. The most recent drought (July to August 2019) took place during the maturation of coffee cherries, resulting in smaller bean sizes and more susceptibility to disease.

In addition, the global coffee sector is experiencing the lowest prices it has seen in more than a dozen years. This low market price for coffee is hitting particularly hard in Central America, where coffee production plays a critical role in the livelihoods of 1.3 million people in Guatemala, Honduras, Nicaragua and El Salvador, the poorest countries in Central America.

Lutheran World Relief field staff is receiving reports about how rural families are accumulating debt and cutting expenses by withdrawing their children from school, eating less and postponing doctor visits, leaving them without any resources to invest in their farms. For some, their only option is giving up farming. For them, it’s common to join the dangerous migratory route north through Mexico to the U.S. to seek employment.

Response: Lutheran World Relief is working in coffee-growing communities in El Salvador, Honduras and Nicaragua to mitigate the effects of climate change and drought by providing sources of clean water, distributing drought-resistant seed and food packages where necessary, and providing technical support to create backyard gardens so families can grow food to sustain them through the thin months between harvests.


**A spike in deadly attacks by extremist militias has created a situation of insecurity across the Sahelian countries of Burkina Faso, Mali and Niger to a point where the head of the U.N.’s World Food Program declared that the region is embroiled in a "three-country crisis" that is causing widespread displacement and hunger.**

The conflict has its roots in the 2012 takeover of northern Mali by Islamic militants who had joined common cause with northern separatist forces. The former have been driven out of most cities by French and UN troops and a tenuous peace made with the latter. However, the insecurity has spread and saw a spike in 2019 with a three-fold increase in violent attacks — no longer by Islamic extremists, but principally sectarian and inter-ethnic conflicts — in Burkina Faso and Niger as well as Mali. Militant groups have learned to play on ethnic tensions, unemployment and heavy-handed or corrupt local security forces.

In Burkina Faso alone, violence has forced nearly half a million people to flee their homes, and nearly a third of the country is effectively a conflict zone. Among the most serious incidents, gunmen stormed a church in early December and opened fire, killing 14 worshipers.

**Response: ** Lutheran World Relief is working in all three countries to build the resilience of farming communities so they can endure both the difficulties of climate shocks, such as prolonged drought, as well as the hardships caused by the effects of violence in and near their communities. As an example of the new normal, Lutheran World Relief has its largest agricultural projects in this region embroiled in conflict, working to help farmers and cooperatives capture significantly more income from local and international value chains. These efforts include a sesame marketing initiative in Burkina Faso and a large resilience project in Niger that leverages public and private sector investments to increase farmer incomes through improved agricultural production and marketing, with a focus on onions, small animals, cowpeas and wheat. Partners NASA Harvest and Lutheran World Relief are using satellite data to help small-scale farmers in West Africa to view and monitor crop conditions, providing information that can help them prepare for and react to weather disasters like droughts and floods.


Northern Iraq continues its process of recovery following the Islamic State’s three-year occupation of Mosul and the devastation resulting from the liberation of the city in 2017.

Aerial bombing heavily damaged many neighborhoods, especially in West Mosul, and remnants of the Islamic State continue to operate in the region. Tremendous needs remain both for the people who stayed in Mosul during the occupation and military offensive, as well as for families returning after having fled. Security remains a challenge with both Shiite militias and remnants of ISIS creating serious risks for local populations and discouraging more returns.

In addition, an ongoing series of protests in central and southern Iraq, including the recent attack on the U.S. Embassy in Baghdad, have resulted in hundreds of deaths and casualties. The demonstrations, which started in October, center on opposition to the central government’s corruption, unemployment and inefficient public services, as well as Iranian influence in the country.

Response: Lutheran World Relief works in the northern Iraq province of Ninawa, as well as the city of Erbil in Kurdistan, responding to the needs of communities recovering from the conflict associated with the occupation and liberation of the city. Projects focus on assisting returning internally displaced people, particularly women, to increase food security and family income by offering vocational training leading to securing employment or starting a business.


Following five years of civil war and near-constant conflict after achieving its independence in 2011, hope is on the horizon for South Sudan. The 2018 peace agreement has ushered in a period of relative stability, although pockets of conflict remain.

The country must now grapple with the cumulative effects of conflict, including mass displacement and a government that struggles to provide the most basic services to its citizens. More than 2 million South Sudanese are refugees, and nearly 1.5 million remain internally displaced. The U.N. estimates that more than 7 million people, two-thirds of the country’s population, are in need of urgent humanitarian assistance.

South Sudan has also been a dangerous place for aid workers. The country has seen the greatest number of attacks on aid workers for the past four years. Since 2013, 115 aid workers have been killed, most of them South Sudanese, in both crossfire and direct attacks. In October, three aid workers from the International Organization for Migration were killed in a battle between government forces and a militia.

**Response: **IMA World began working in South Sudan in 2008, three years before independence, and has focused its health and nutrition programs in Jonglei and Upper Nile, two of the most conflict-affected states.With support from the U.S. Agency for International Development’s Office of Foreign Disaster Assistance, IMA provides vital primary health care and emergency health services through 10 mobile clinics and nutrition services through 26 sites operated by three local partners working in the former Upper Nile and Jonglei states. Working with the U.N.’s family planning agency, IMA World Health is also supporting mobile clinics and building community capacity to provide reproductive health services, with a particular focus on addressing sexual and gender-based violence.


The political and economic crisis continues to debilitate Venezuela, a once-wealthy country that is flirting with the possibility of becoming a failed state. Most families have suffered from a steep decline in income and grapple with daily food, medicine and fuel shortages. There is a nearly complete breakdown in water, power and health services.

The crisis is prompting millions of Venezuelans to flee the country, seeking refuge in nearby countries, mostly in Brazil, Colombia, Chile, Ecuador and Peru. By mid-2019, the number of Venezuelan refugees reached the 4 million mark, about 13 percent of its population. The host countries have for the most part shown tremendous solidarity and hospitality to the new arrivals, providing them with protection and assistance. However, the willingness to welcome Venezuelans is on the wane in some areas, and they are increasingly being denied official permission to legally stay that would guarantee them basic rights and the ability to find employment.

Response: Lutheran World Relief is supporting reception centers at Peru’s northern border and in Lima, where Venezuelans can find temporary housing, meals and legal counseling about residence, work permits and other regulations. As part of the outreach effort, Lutheran World Relief created Ven Informado, a digital platform accessible through Facebook, Instagram or WhatsApp offering practical information and real-time advice for Venezuelan refugees on subjects like immigration, laws and customs, and life in Peru. Lutheran World Relief is also advocating for the rights of the migrants and supporting services for displaced women and children as they integrate within host communities in Peru.