A Long Walk, A Short Sachet: Two Karamoja Mothers on the Front Line of Hunger

Kotido/Kaabong, Uganda — By 11:00, the heat is already hard.

At Rengen Health Centre in Kotido District, Karamoja, women press against the veranda wall, pulling their children closer as the sun pushes across the compound. Some fan babies with referral cards. Others stare ahead. 

Anna waits with Loketch on her lap.

He is three. His hair has turned a dusty brown — one of the signs that told health workers he was in trouble. Anna is pregnant. Tired, too. They walked nearly 6 km to reach the health centre.

“When my child fell sick, health workers came to my village and during screening they found my child was malnourished,” she says. “They told me to bring him here. Since he started taking the peanut paste [Ready to Use Therapeutic Food], I have seen a change.”

Loketch has severe acute malnutrition (SAM) — the most dangerous form, the kind that kills without treatment. He is enrolled in UNICEF-supported outpatient care and is fed on sachets of ready-to-use therapeutic food, which help him gain weight.

Nearly 65 kilometres north, in a Kaabong manyatta – a pastoralist homestead community - another mother lives through the earlier chapter of the same story.

The village before the health centre

Empty granaries. Grass-thatched houses clustered behind shrub fences. Stacked firewood. Old men in shawls and faded t-shirts gather under a tree, listening to a radio. Dogs stretch out in the open ground. Children walk past, smiling. The men sniff medicinal tobacco — they say it clears the flu.

This is where Regina Kine, 30, raises five children. Her youngest daughter, Perinina, aged 2, was screened by a Village Health Team and found to have moderate acute malnutrition (MAM), which, if unattended, quickly worsens, increasing the risk of the severe form Loketch is battling. 

“I really knew because there was no food in my house. We survive on the green leafy vegetables I bring from the garden,” Regina recalls the moment she got the results. “My breast milk could not satisfy the child.” 

Catching children at Perinina's stage — before they slip into Loketch's — is where WFP focuses. When the community team came to her village, they registered Perinina into the targeted supplementary feeding programme and gave Regina a month's ration: 30 sachets of ready-to-use supplementary food and one packet of Super Cereal.

“In each day of the week, I give my child one packet,” Regina says. “I have noticed a little body gain. It gives me hope.”

Closing the care gap

In 2026, WFP and UNICEF are mounting a joint response, funded through the Uganda Humanitarian Fund: prevention and MAM treatment from WFP; SAM treatment and active case finding from UNICEF; and referral shared.

UNICEF will screen 90,000 under-5s and treat 15,500 for severe malnutrition; WFP targets 27,000 moderate cases and 3,000 mothers with support, delivered in kind or through cash-based transfers, focusing on Kaabong, Kotido, and Moroto.

“For the first time, we are bringing cash into the nutrition response,” says Juliana Muiruri, Head of Nutrition at WFP Uganda. “It puts families in control of preventing poor nutrition — helping them access nutritious foods and essential services locally. Prevention is critical: it is how we keep children well and out of inpatient care.”

UNICEF picks up the next phase. When malnutrition screening tapes turn red — and a childlike Loketch is found to be wasting — UNICEF ensures therapeutic foods are available in health facilities, trains staff to manage the worst cases, and supports inpatient wards when complications arise.

“No child should wait until severe malnutrition threatens their life before they get help,” says Zakaria Fusheini, Chief of Nutrition at UNICEF Uganda. “The earlier we find children at risk, the better their chance of survival.”

Why it matters now

The 2026 Integrated Food Security Phase Classification, released this June, puts the numbers behind the current scale of malnutrition in Karamoja.

Between April and July 2026, 473,000 people in the region — about 32 percent of the analysed population — face crisis-level hunger or worse, including roughly 41,000 in IPC Phase 4 (Emergency). Kaabong and Kotido — the districts Regina and Anna call home — are classified in IPC Acute Malnutrition Phase 4 (Critical), the most severe tier. Across 43 districts of Uganda, 428,000 children aged 6–59 months and 84,000 pregnant or breastfeeding women need malnutrition treatment in the year ahead.  

Karamoja's recovery from the 2023–24 crisis has not landed evenly. Rains stay erratic. Prices stay high. Only 18 percent of young children receive a minimum acceptable diet. Without prevention and early treatment, children cycle from MAM into SAM into the inpatient ward — and sometimes do not come back.