According to the 2019 GHI, of the countries for which data are available, four suffer from levels of hunger that are alarming, and one country, the Central African Republic, suffers from a level that is extremely alarming. The four countries with alarming levels of hunger are Chad, Madagascar, Yemen, and Zambia. Forty-three countries out of 117 countries that were ranked have serious levels of hunger. It is critical to understand that GHI scores for several countries could not be calculated because data were not available for all four GHI indicators. However, the hunger and undernutrition situations in nine of these countries—Burundi, Comoros, Democratic Republic of Congo, Eritrea, Libya, Papua New Guinea, Somalia, South Sudan, and Syria—are identified as cause for significant concern (Box 2.1). In some cases, the hunger levels might be higher than in the countries for which GHI scores were calculated.

To understand how the countries included in the GHI compare with each other, Table 2.1 shows the numerical ranking, from lowest to highest hunger levels, for each country with a 2019 GHI score. Appendix E shows how countries compare with others within their regions and how each country’s GHI score has changed over time. Appendix C shows the values of the GHI indicators—the prevalence of undernourishment, child wasting, child stunting, and child mortality—for each country, including their historic values. An examination of the individual indicators provides a useful glimpse into the nature of hunger and undernutrition in each country and how it has changed over time.

For nine countries with GHI scores in the moderate, serious, alarming, or extremely alarming categories, their 2019 GHI scores are higher than their scores for 2010, which is the most recent historical reference period in this year’s report. These nine countries are the Central African Republic, Jordan, Lebanon, Madagascar, Malaysia, Mauritania, Oman, Venezuela, and Yemen. Venezuela’s GHI score has doubled since 2010, reflecting the severe food shortages and the economic and political crises that have gripped the country in recent years. Hyperinflation, a rapidly contracting GDP, overdependence on oil revenues coupled with falling oil production, and poor governance characterized by rampant corruption and growing autocracy have all contributed to the situation (Labrador 2019). Venezuela’s GHI score could quite possibly be higher in future years when more up-to-date data on child nutrition become available.

The Central African Republic has the highest 2019 GHI score in this report—53.6—and is the only country that falls into the extremely alarming category of the countries with sufficient data for calculating their GHI scores. Nearly half of all children in the Central African Republic are stunted, and 60 percent of the population is undernourished. Since 2012 the country has been embroiled in a civil war, contributing to a crisis of hunger and undernutrition. As of June 2019, 605,000 refugees had left the country and an additional 655,000 people were internally displaced out of a population of just 4.7 million (UNHCR 2019d; UN DESA 2019). More than half of the population is in need of humanitarian assistance in 2019, although security concerns often prevent aid agencies from reaching those in need (USAID 2019a). A peace agreement was signed between the government and warring factions in February 2019, but violations of the terms threaten to undermine the agreement (Schlein 2019). The situation in the Central African Republic clearly demonstrates the role that conflict plays in worsening hunger and undernutrition.

At 45.9, Yemen’s GHI score is the second highest in this year’s report and falls into the alarming category. Its child stunting and wasting rates are estimated to be 61.1 and 17.9 percent, respectively. The country has been affected by civil war since 2014, although there are in fact multiple conflicts at play whose roots go as far back as the 1990s (Ahram 2019). In November 2018 UNICEF’s regional director for the Middle East and North Africa, Geert Cappelaere, warned that the war and ongoing economic crisis have had dire impacts on the children of Yemen, including extreme hardship, elevated rates of malnutrition and disease, and increased mortality (Cappelaere 2018). The warring factions signed the Stockholm Agreement in December 2018 to ease the conflict and humanitarian crisis, but as of June 2019 the agreement had still not been fully implemented and some civilians and communities in need were still blocked from receiving humanitarian aid (UN 2019b). It is estimated that 17 million people out of a population of 28 million (World Bank 2019a) will face crisis-level food insecurity or worse through early 2020, with some areas in the west of the country facing emergency-level food crises. If the security situation deteriorates, the country is at risk of famine (FEWS NET 2019a).

Chad has the third-worst GHI score according to this year’s ranking; at 44.2, it is considered alarming. Chad’s child mortality rate is 12.3 percent, the second-highest rate in this report. Chad ranks 186th out of 189 countries in the Human Development Index, with only South Sudan, the Central African Republic, and Niger ranking worse (UNDP 2018). In recent years Chad has also experienced an influx of refugees, primarily from South Sudan, the Central African Republic, and Nigeria. By the end of 2018 the number of refugees exceeded 450,000, with more arriving in 2019, putting a strain on resources in the host communities (UNHCR 2019f; UN 2019a). In the Lake Chad basin, incursions of armed groups into Chad from neighboring Nigeria have increased insecurity and disrupted livelihoods, access to markets, and trade (UN OCHA 2019a).

In addition to considering countries’ GHI scores and rankings, it is useful to compare countries’ individual GHI component indicators:

Haiti, Zimbabwe, and the Central African Republic have the highest rates of undernourishment, ranging between 49.3 and 59.6 percent.

Stunting rates are highest in Madagascar, Burundi, and Yemen, where data or estimates show that more than half of all children under five suffer from stunting.

Wasting is most prevalent in Yemen, Djibouti, and India, ranging from 17.9 to 20.8 percent.

The highest under-five mortality rates are in the Central African Republic (12.2 percent), Chad (12.3 percent), and Somalia (12.7 percent).

The situation is more positive in many countries in terms of both their GHI scores and their progress in reducing hunger and undernutrition over time. This year’s GHI includes 23 countries with moderate levels of hunger and 46 countries with low levels of hunger. Of the countries with moderate levels of hunger, two—Myanmar and Senegal—had alarming hunger levels as recently as 2000. Of the countries with low levels of hunger, five had serious hunger levels as recently as 2000: Albania, Azerbaijan, Mongolia, Panama, and Peru.

Figure 2.2 shows the progress countries have made since 2000, along with their 2019 GHI scores. Perhaps most informative is the dramatic improvement in GHI scores for the countries on the lefthand side of the figure, particularly Angola, Rwanda, and Ethiopia. These countries each had GHI scores in the extremely alarming category in 2000, largely as a result of civil wars. As is evident throughout this report, violent conflict and war are strong drivers of hunger and undernutrition, yet it is important to realize that even the worst situations can improve with the return of peace and stability.

As noted in the About section, GHI scores are not calculated for some high-income countries where the prevalence of hunger tends to be very low. This gap occurs mainly for two reasons: (1) not all GHI indicators are appropriate for assessing hunger in these countries and (2) some data are unavailable because they are not regularly collected there. Nonetheless, the high-income countries that are not included in the GHI are not immune to food insecurity.

High-income countries show variable, non-negligible rates of food insecurity as measured by locally adapted household food security scales that yield comparable results: 5 percent of households were food insecure in South Korea in 2008, 7 percent in Canada in 2011– 2012, 12 percent in the United States in 2017, and 17 percent in Portugal in 2005–2006 (Kim et al. 2011; Tarasuk, Mitchell, and Dachner 2014; Coleman-Jensen et al. 2018; Álvares and Amaral 2014). In the United States, 16 percent of households with children under age 18 were food insecure in 2017 at some point during the year (Coleman-Jensen et al. 2018), and a UNICEF study regarding food insecurity in the 28 countries of the European Union found that 18 percent of households with children under age 15 experience moderate or severe food insecurity based on the Food Insecurity Experience Scale (Pereira, Handa, and Holmqvist 2017). The experience- based concept of the household food security scale and measures such as the Food Insecurity Experience Scale should not be confused with the measurement approach of the undernourishment indicator, which reflects shortfalls in calorie intake; the prevalence estimates that result from these two types of measures are not comparable (Ballard, Kepple, and Cafiero 2013).