As millions of people across northern Nigeria face severe food insecurity, children continue to bear the consequences of a deepening malnutrition crisis. But the impact is far beyond the children in treatment. This can be a source of significant anxiety, exhaustion, and emotional distress for parents and caregivers, particularly those who spend weeks in the hospital when a child is severely malnourished and are concerned about starving children at home.

The Food and Agriculture Organization (FAO) estimates that 34.7 million people in Nigeria are in crisis levels of food insecurity during the lean season, while more than 5.4 million children are acutely malnourished. In northern Nigeria in 2025, MSF teams provided treatment to 425,634 children who were suffering from acute malnutrition.

The food crisis has particularly affected Nigeria's northeastern states of Borno, Adamawa and Yobe. It is estimated that by 2026 nearly 5.8 million people will be severely food insecure. In Borno State, conflicts, climate shocks and displacement are interfering with people's means of livelihood and damaging local food production, putting about 15,000 people at risk of suffering from catastrophic hunger.

The World Food Programme (WFP) has warned that ongoing insecurity is worsening hunger by forcing communities to flee their homes, preventing farmers from accessing their land and restricting the delivery of humanitarian assistance.

Monica Genya, Association Director at Doctors Without Borders (MSF) Southern Africa, described the "situation as critical," with medical teams treating children suffering from severe acute malnutrition and related illnesses.

In MSF nutrition facilities such as Nilefa Kiji in Maiduguri, she said, teams see intensive care units full of children fighting severe acute malnutrition. Many arrive severely wasted, and because malnutrition weakens their immunity, many also have illnesses such as measles, diphtheria and malaria, she said.

"It is severe, and it is life-threatening for many children," said Genya.

In 2025, MSF treated 353,989 children for severe acute malnutrition (SAM) and 90,723 for moderate acute malnutrition (MAM). She said that SAM is the most dangerous form that continues to claim young lives in the region. Children are severely wasted, and their immune systems are weakened. Some arrive at treatment facilities already suffering from diseases such as measles, diphtheria and malaria. Treatment can last anywhere from a week to more than a month, leaving caregivers facing prolonged separation from the rest of their families.

Genya said MSF treated 41.8 per cent more children for acute malnutrition in 2025 than in the previous year, reflecting a worsening crisis. Admissions have risen steadily since 2022, driven by insecurity, displacement, food shortages, disease outbreaks, economic hardship and cuts to humanitarian funding.

"These pressures compound one another, so more families are pushed to the edge each year," she said.

The rising number of children requiring treatment also raises questions about whether humanitarian resources are keeping pace with the need. MSF supports the state Ministries of Health in Zamfara, Katsina, Kebbi, Borno, Bauchi, Sokoto and Kano.

Supporting caregivers as part of treatment

Genya said that the emotional burden carried by caregivers is often overlooked in discussions about child malnutrition, where attention tends to focus on medical treatment, admissions and recovery rates.

"Medical statistics capture admissions and recovery rates, but they cannot measure the emotional burden carried by the person at the bedside, who is most often the mother," she said. Caregivers endure fear, anxiety, guilt, uncertainty and emotional exhaustion, and some develop symptoms of depression."

The consequences extend beyond their own wellbeing. This matters for the child's recovery too. A caregiver's emotional wellbeing influences how engaged they stay in treatment, whether they follow medical advice and how well they can care for the child after discharge.

"Caring for the caregiver is part of caring for the child," she said.

The competing demands on caregivers are evident in the experiences MSF counsellors encounter at its nutrition facilities in northern Nigeria. "Caregivers are pulled in two directions," said Genya. "Many arrive with a critically ill child while having left other children at home, sometimes with no one to look after them and little to eat."

Their worry does not stop when treatment begins. Genya recalled the experience of a mother in Maiduguri.

"One mother in Maiduguri told us she had left eight children at home, and when she heard one had a fever and there was no money for treatment, she cried and could not eat. Another was asked by her eldest son when she was coming home, because the children were hungry without her," she said. In another case, counsellors met a mother of six who had to leave the hospital because her husband had left the children with neighbours and she could not bear to stay.

"These stories show how guilt, worry and separation can put a child's treatment at risk, which is why we listen and respond," she said.

Recognising the emotional toll of malnutrition, MSF incorporates mental health and psychosocial support into its nutrition programmes.

At Nilefa Kiji, caregivers receive psychological first aid on arrival, followed by individual counselling and group sessions where they can share experiences, express their fears and learn coping strategies. Caregiver education helps families understand and manage the emotional and behavioural challenges that can arise during and after treatment. Children take part in structured play activities that help restore a sense of normalcy during recovery.

"The support is also practical," she said.

Counsellors help distressed caregivers reach relatives by phone, and in some cases supervised home visits let a caregiver briefly check on their family before returning to finish their child's treatment. She said that this helps caregivers cope, builds their confidence, supports treatment adherence and contributes to better recovery. "Many regain hope as they watch their children get better, and some come back after discharge just to show how healthy their children have become," said Genya.

Beyond treating malnutrition

For MSF, addressing the crisis requires more than treating children after they have become severely malnourished. Families must also be reached earlier, before food insecurity and other pressures push children into life-threatening conditions.

"Treating children once they are already severely malnourished saves lives, but we also need to reach families before they get to that point," she said.

Insecurity and displacement, disease outbreaks and economic hardship continue to undermine families' ability to provide adequate food and care. Genya said prevention and treatment must go hand in hand, alongside support for caregivers who bear much of the responsibility for children's recovery.

She added that the pressures pushing children into malnutrition, including insecurity and displacement, food insecurity, disease outbreaks and the economic crisis, are not easing. Sustained funding is needed not only for nutrition services but also for mental health and psychosocial support, she said. Governments and humanitarian organisations must work to ensure families can access essential assistance before children reach the point of severe malnutrition.

"This is why MSF's work focuses on both prevention and treatment, and why we care for the whole family, including the caregivers at the bedside, through counselling and psychosocial support. This work depends on public support," she said. "Donating to MSF's humanitarian efforts helps our teams keep reaching children across northern Nigeria, treating them early and supporting the families who care for them."

With over 5.4 million children acutely malnourished this year, every contribution makes a difference, she said.

As the world marks World Food Day, the experiences of families in northern Nigeria underline the need to recognise the human cost of food insecurity beyond the physical effects of hunger.

Genya said that addressing the crisis requires supporting caregivers alongside treating children. She said that there is a need to support caregivers through mental health and psychosocial services. She said that behind every child in our facilities is a caregiver, most often a mother, living with fear, anxiety, guilt and exhaustion. Many are worried sick about children left at home without enough food. Their emotional wellbeing shapes whether they can stay engaged in treatment, follow medical advice and keep caring for their child after discharge.

"Recognising and supporting caregivers is therefore key to ending this crisis, not a side issue," she said.

She urged donors to reconsider humanitarian funding cuts and sustain investment in nutrition care, including mental health and psychosocial support, to ensure children and their caregivers receive the help they need. "Behind every statistic is a caregiver's mental health impacted by malnutrition," said Genya.

The fear of losing a sick child, combined with guilt over being separated from other family members, can take a significant toll on their mental well-being. "A mother sits at a hospital bedside, grateful that her child is improving, while worrying that her other children at home have nothing to eat. She is afraid of losing the child in front of her, and guilty about those she can't be with," she said. "These are people showing extraordinary resilience under immense strain, and their stories rarely get told."

"Healing is not only about restoring a child's weight," said Genya. "It is also about restoring hope and resilience to the person who sits at the bedside every day."