The acute malnutrition situation in South Sudan continues to deteriorate. Similarly to acute food insecurity, this projection update shows an increase in the number of children suffering acute malnutrition from 2.1 million to 2.2 million, representing approximately 90,000 additional cases requiring treatment. Similarly, the number of pregnant and breastfeeding women requiring treatment has increased from 1.1 million to 1.2 million, signalling a growing demand on an already strained health and nutrition system. Out of the 29 analysed areas, 25 counties show deterioration in acute malnutrition, especially in Jonglei, Upper Nile, and Unity states. 

A total of 10 counties and the Abyei Administrative Area are classified in IPC Acute Malnutrition (AMN) Phase 5 (Extremely Critical). The counties include Baliet, Akoka, Luakpiny/Nasir and Ulang (Upper Nile), Abiemnhom and Rubkona (Unity), and Duk, Akobo, Fangak and Uror (Jonglei). Compared to the September 2025 IPC AMN projection, multiple counties have deteriorated into more severe phases—notably Akobo, Fangak and Uror (Jonglei), Baliet (Upper Nile), and Abiemnhom (Unity)—while others have worsened within already critical levels of acute malnutrition.

Given the gravity of these conditions, a detailed risk of Famine analysis was conducted in seven counties to assess the likelihood of further deterioration. It determined there is a risk of Famine in Luakpiny/Nasir and Ulang (Upper Nile) and Nyirol and Akobo (Jonglei) under a worst-case scenario involving renewed escalation of conflict, further large-scale displacement, and reduced humanitarian access to highly vulnerable communities. This marks a significant worsening compared with the previous analysis period, when one county was identified as facing a risk of Famine, with the number now rising to four counties. Risks are particularly acute in Akobo, where the potential return of approximately 100,000 South Sudanese currently displaced in Gambela, Ethiopia, could overwhelm already depleted resources and services.

The deterioration in both food security and nutrition is driven by a combination of interlinked factors. Conflict and displacement have disrupted livelihoods, limited access to productive assets, and cut off populations from markets and services. Restricted humanitarian access and insecurity have constrained the delivery of assistance, while prolonged isolation has left some communities without support. Market collapse and rising food prices have reduced household purchasing power, further limiting access to food. At the same time, conflict and flooding have reduced access to medical infrastructure and nutrition services, compounded by severe funding shortages, which have led to a scale down of health and nutrition programmes, supplies, and staff. The nutrition situation is further aggravated by a high and increasing disease burden, including cholera, measles, malaria, diarrhoea, and acute respiratory infections, alongside poor sanitation conditions and limited access to safe water. Disruptions to supply chains due to insecurity have resulted in stockouts of essential nutrition commodities and medical supplies, including preventive services such as vitamin A and deworming.

1. Restore and expand lifesaving nutrition services: Rapidly scale up OTP, TSFP, and BSFP in IPC AMN Phase 4 and 5 areas, including the reactivation of closed facilities, relocation of services to areas where populations have moved whenever feasible, and deployment of mobile and outreach teams, with particular focus on displaced populations with limited access to services. 
2. Strengthen health and supply systems: Ensure uninterrupted availability of essential drugs and nutrition commodities (SAM/MAM), particularly in locations that have reported extended periods without medical consignments and nutrition supplies, through prepositioning ahead of the rainy season and strengthening last-mile delivery systems, prioritising areas hosting displaced populations with high service demand.
3. Scale up integrated nutrition, health, WASH, and IYCF interventions: Strengthen cholera prevention and response as this remains a critical public health concern, alongside intensified response to malaria, diarrhoea, and ARIs, expansion of safe water access, sanitation, and hygiene promotion, and strengthening Infant and Young Child Feeding (IYCF) interventions to promote optimal breastfeeding and complementary feeding practices, particularly in displacement affected areas with compromised hygiene conditions and flood-prone locations. Integrated response leveraging on partner resources and strengths will provide a holistic approach in meeting the needs of te children with optimised impact for all.
4. Expand food and nutrition support to vulnerable populations: Increase emergency food assistance and scale  up blanket and targeted supplementary feeding programmes in areas with disrupted services, including locations classified in very critical phases, with specific targeting of displaced populations whose food consumption is significantly compromised.
5. Strengthen systems, workforce, and coordination: Invest in frontline workforce capacity (including staffing and incentives), reinforce coordination and access negotiations to sustain service delivery in insecure and underserved areas, and adopt innovative data collection approaches in displacement-affected and hard-to-access locations to ensure timely and reliable information for response planning.