Almaz Tilhun recalls the sound of gunshots and screams in her Ethiopian village last year.

The 40-year-old's husband went outside to see what was happening.

"This was the last time I saw him," Ms Tilhun said.

In shock, she fled with her six children. Only later did she discover he had been shot and killed.

Her 23-year-old son, "unable to cope with his father's loss", took his own life.

"When I heard about this, a part of me died as well," she said.

Ms Tilhun's story is one shared in the Suffering in Silence report released on Thursday by aid agency CARE.

She is just one of the 1 million people recently displaced in the ethnic conflict in Gedeo and West Guiji zones in Ethiopia last year, but according to the report, global audiences are unlikely to have even heard of it.

In countries like Niger, crises like hunger and poverty are being largely under-reported in the global media, according to a new report from CARE. ( Supplied: Josh Estey, CARE )

Rachel Routley from CARE Australia's Emergency Response Unit said the charity paired with a media monitoring group to see which humanitarian crises that affected 1 million people or more garnered the least media coverage in 2018.

"Many of these stories can be heartbreaking, but it's still the responsibility of media to share the actual situation on the ground and explain what is happening," she said.

1. Haiti

Almost a quarter of Haiti's children, 22 per cent, are chronically malnourished. ( Supplied: Stephania Musset, CARE )

"The situation in Haiti at the moment is dire," Ms Routley said.

More than half its population, or 5.5 million people, are constantly facing the threat of hunger, and almost a quarter of the nation's children are chronically malnourished.

"The food security situation is closely related to shocks from natural disasters, increased fuel prices and an unstable exchange rate," the report said.

Hurricanes Irma and Maria wreaked havoc in 2017, causing significant flooding, while a magnitude-5.9 earthquake struck north-western Haiti in October last year.

Cholera remains a problem and half the population earn less than $1.40 a day.



2. Ethiopia

Women line up to collect monthly rations in drought-affected Ethiopia. ( Supplied: Josh Estey, CARE )

Ethiopia has the unfortunate distinction of having two crises named on the list: its complex hunger crisis, in part due to a two-year drought affecting millions; and the mass displacement of more than 1 million people — including Ms Tilhun — due to violence.

"It was the largest internal displacement that the world saw last year," Ms Routley said, but according to the report, it was listed at number seven on the list and "went largely unnoticed in the shadows of multiple emergencies battering Ethiopia".

With 84 per cent of Ethiopians living in rural areas and relying on farming for their livelihoods, they are increasingly impacted by climate change, which has other knock-on effects.

"Coping with the loss of livelihood also leads to increases in children dropping out of school, child marriage and child labour," the report said.

3. Madagascar

Tema Bonanee, widow, has six children and struggles to feed them, with a lack of access to water making it difficult to grow agricultural goods. ( Supplied: Myriam Rivo, CARE )

The report describes the island of Africa's east coast as being on the "frontlines of climate change".

"A vicious combination of consecutive years of drought and the effects of the El Niño climatic cycle has withered corn, cassava and rice fields in Madagascar," it said.

On top of the drought crisis, two cyclones in 2018 lashed the country, displacing tens of thousands of people.

Almost half of the country's children are stunted, impacting their mental and physical growth for the rest of their lives.

The country has also been impacted by disease — in September and October, 103 suspected cases of bubonic and pulmonary plague were reported. Of those, 38 were confirmed and there were seven deaths.

4. Democratic Republic of the Congo (DRC)

Francois Xavien is an advocate for women's rights in his community in Goma, DRC, where ongoing conflict has led to displacement and sexual violence. ( Supplied: Jake Lyell, CARE )

More than two decades of conflict have led to a "vicious cycle of violence, disease and malnutrition" in troubled DRC.

Stefan Knollmayer, CARE Australia's emergency response manager, said it was often difficult or unsafe for international media to get access to the war-torn country.

"As a result, Australians are not only hearing very little about the conflict, but they've also heard very little about the new Ebola outbreak that has killed 500 people in the DRC since August 2018," he said.

Gender-based violence is also a huge issue, with CARE sharing the story of one woman, Pema, who was raped and impregnated at just 14. She was forced to marry her rapist.

She said she almost died from a number of forced pregnancies until she convinced her husband to sign papers for her sterilisation.

5. The Philippines

A child sits on the remains of a wrecked hut in the Philippines, where some tropical disasters are more widely reported than others. ( Supplied: Jiff Ang, CARE )

Typhoon Mangkhut was considered the strongest tropical cyclone of 2018, yet the impact when it made landfall in the Philippines went largely unnoticed.

The disaster affected 3.8 million people, killing 82 and injuring 130 in massive landslides and floods. One month later, another typhoon struck, devastating communities that had just begun to recover.

Today those communities are still impacted by the destruction of shelter and crops, Ms Routley said.

"One of the slight positives was that there was a relatively low death count, and that speaks to the strength of having people who are well prepared to respond to emergencies," she said.

Why the global media silence?

The vast majority of those listed in the report are out of Africa.

Arnaud Froger, from Reporters Without Borders Africa, said that limits on press freedom in some countries could be a hindrance to those stories being heard.

"The duration of prolonged crises often tends to erode the interest of the media," he said, adding budget restrictions for major international outlets might push them to focus on "hard news" topics rather than long-lasting issues.

"It is sometimes very difficult to obtain a visa to cover the most sensitive subjects in some of these countries.

"Extensive administrative procedures, negotiations with several authorities and high fees are all techniques widely used to prevent or at least limit the arrival of foreign journalists in some countries."

Ms Routley said a sense of fatigue could impact whether a story was considered "newsworthy" but that journalists had a responsibility to report.

She said the consequences of humanitarian crises going under-reported meant it was "harder get aid to people when there is a lack of public awareness and political will" to respond.

"The suffering of the people in these protracted crises is just as severe and is just as worthy of our attention and support as an immediate natural disaster," she said.