Tirana Hassan speaking with staff of Médecins Sans Frontières in Drouillard, Haiti, where she visited in March 2026.
Marx Stanley Léveillé, MSF
Tirana Hassan, the chief executive of Doctors Without Borders in the United States, has spent much of her career confronting the human consequences of conflict. Among them, she argues, hunger remains one of the most widely misunderstood.
It is often framed as a simple absence of food. In reality, she says, it is far more complex—rooted in political decisions, structural inequalities and, in some cases, deliberate actions.
Across modern conflict zones and humanitarian emergencies, from Sudan and Chad to the Gaza Strip and Somalia, hunger rarely emerges in isolation. It takes hold in places already under strain, compounding existing vulnerabilities and reflecting the broader dynamics of war.
“The most vulnerable communities are already at risk,” says Hassan. “They are often reliant on farming, on fragile livelihoods. And when conflict hits, those vulnerabilities are even more exposed.”
Doctors Without Borders—also known by its French name, Médecins Sans Frontières, or MSF—is an independent medical humanitarian organization that provides emergency care in conflict zones and disaster settings. Its teams treat a wide range of conditions, from war injuries to disease outbreaks and severe malnutrition, often in places where health systems have collapsed or access to care is otherwise out of reach.
Hassan assumed leadership of the organization’s U.S. arm in January, during a period in which the operating environment for humanitarian groups has become increasingly constrained.
“Around the world, we're seeing both cuts in funding for international assistance and a shrinking humanitarian space for aid workers to do their jobs safely,” she says. “Attacks on hospitals, health workers, and civilians are happening with unacceptable regularity.”
What her teams are witnessing, she added, is hunger shaped not only by scarcity, but by systems under pressure—and, in some cases, by the deliberate restriction of food and humanitarian access.
Conflict is now the single largest driver of hunger worldwide, according to the United Nations. The World Food Programme estimates that nearly 70% of people facing acute food insecurity—around 219 million—live in fragile or war-affected settings. Action Against Hunger puts the number of people experiencing hunger directly tied to conflict at roughly 140 million across 20 countries.
New analysis from WFP warns the situation could worsen: nearly 45 million additional people may be pushed into acute food insecurity or worse (IPC Phase 3 and above) if the conflict in the Middle East persists through mid-year and global oil prices remain above U.S. $100 a barrel.
The disruption created by war is both immediate and systemic. War halts planting and harvests. It empties markets. It forces families to flee. It severs supply chains and restricts humanitarian access. It turns food from something grown and traded into something scarce and contested.
And increasingly, something controlled.
International law is explicit on this point. Starvation of civilians as a method of warfare is prohibited under the additional protocols to the Geneva Conventions, and this principle was reaffirmed by United Nations Security Council Resolution 2417 in 2018. In practice, violators frequently disregard that prohibition, and enforcement is rare.
Across multiple conflicts, humanitarian organizations are documenting a troubling pattern: food, and access to it, is being deliberately manipulated.
“There is hunger by design,” says Hassan. “We see humanitarian aid used as leverage, as punishment, as a way to exert control over civilian populations.”
The practice, prohibited under international humanitarian law, has resurfaced repeatedly in recent years. Siege tactics, blocked aid convoys, and restrictions on humanitarian access have left civilian populations effectively cut off from food.
In Sudan, both sides in the ongoing conflict—the Sudanese Armed Forces and the Rapid Support Forces—have been accused of obstructing aid, destroying food supplies, and targeting humanitarian workers.
The crisis has driven a mass exodus into neighboring countries, particularly Chad, which is struggling to cope with the scale of need.
Since the war began in 2023, parts of Sudan have slipped into what aid workers describe as near-famine conditions. In late 2025, civilians who managed to flee the besieged western city of El-Fasher after months of isolation recounted extreme deprivation.
“They were so hungry, they told us they began to eat animal feed,” Hassan says. “People were shot by the Rapid Support Forces trying to bring food in to El Fasher.”
In Gaza, MSF has gone further, describing what it called the “deliberate use of starvation as a weapon” by Israel last year, accusing authorities of ‘instrumentalizing’ humanitarian assistance and using access to food and aid as a tool of control.
An eight-month-old severely malnourished baby is examined by an MSF nurse in Khan Younis, Gaza.
Nour Alsaqqa for MSF
Since early 2026, the organization has been unable to bring supplies into the territory, following Israel’s decision to ban dozens of international NGOs. International staff have been forced to leave. Locally hired Palestinian staff remain, working under conditions that are, by most accounts, barely sustainable.
“Israel maintains its blockade, preventing sufficient aid from entering the strip, depriving people of the essentials they need to live, and prolonging this genocide,” MSF said in a statement.
In these contexts, hunger operates as both a physical and systemic form of violence.
In facilities run by Doctors Without Borders, children suffering from severe acute malnutrition are treated in therapeutic feeding centers, where they receive nutrient-dense food under close medical supervision. The most critical cases are admitted for inpatient care, where infections and other complications can be managed alongside efforts to stabilize their nutrition.
But treatment, Hassan said, is only one part of a broader response.
“We try to work at every level,” Hassan says. “From community screening to outpatient care, to reinforcing local health systems.”
In countries like Chad—while not itself a war zone—the effects of conflict are deeply felt. The country has become a refuge for people fleeing violence in neighboring Sudan, the Central African Republic and Cameroon, placing additional strain on already fragile systems. More than one million refugees have crossed into Chad in recent years.
Children are give a MUAC, (mid-upper arm circumference) test, to screen for signs of malnutrition inside the Médecins Sans Frontières, (MSF) clinic at the refugee transit camp in Adre, Chad. Children, that include Sudanese refugees, are put on a six to eight week programme, returning each week for further medical checks. (Photo by Dan Kitwood/Getty Images)
Getty Images
Within that context, humanitarian work often extends beyond clinical care. Aid workers train mothers to safely prepare nutritional supplements in places where clean water is scarce, and focus on identifying malnutrition early, before it becomes life-threatening.
In some countries, hunger is not episodic but entrenched.
In Chad, an estimated 5.7 million people are facing malnutrition, including 1.8 million children under five with acute malnutrition. Nearly half of those cases are classified as severe.
“People in Chad are not facing a one-time emergency,” Hassan says. “It is chronic.”
Data from Doctors Without Borders underscores how concentrated these crises have become. In 2023, 67% of admissions to its outpatient therapeutic feeding centers were in just three countries: Nigeria, Niger and Chad. In 2024, the organization treated more than 584,700 children for malnutrition across its programs.
A similar pattern is taking hold in Somalia, where a combination of conflict, climate pressures and funding cuts is driving more children into feeding centers in critical condition.
In such places, hunger is no longer a temporary emergency but an enduring feature of daily life.
The geography of hunger is narrowing even as the scale expands. Meanwhile, the response is contracting.
Across multiple regions, funding cuts are colliding with rising need. The World Food Programme saw projected resources fall by 34% in 2025. The United Nations scaled back its global humanitarian appeal from $47 billion to $33 billion in 2026 after donor support weakened, with aid reaching 25 million fewer people than the year before.
“In 2025, hunger surged. Food budgets were slashed—even as famines hit parts of Sudan and Gaza. Health systems broke apart,” UN Under-Secretary-General for Humanitarian Affairs Tom Fletcher told the Associated Press. “Millions went without essential food, health care and protection.”
For humanitarian organizations, the consequences are immediate and severe. What Hassan describes as “impossible choices” for aid groups and treatment providers are now routine: where to go, who to reach, what risks to accept.
In countries like Somalia, reductions in support from donor countries—linked in part to concerns over aid diversion—have coincided with rising malnutrition rates.
“The reverberations of cuts to food aid and humanitarian assistance are devastating,” Hassan says.
At the same time, the operating environment is becoming more constrained. In some conflicts, access is restricted. In others, aid delivery is increasingly politicized or even handed over to parties within the conflict itself—blurring the line between relief and control.
Tirana Hassan, a social worker, lawyer, and nonprofit executive with over 20 years of experience, stepped into the role of Chief Executive Officer with Doctors Without Borders/Médecins Sans Frontières in the United States in January 2026.
Médecins Sans Frontières
For MSF, the response is both practical and philosophical. The organization is not a food distributor. It treats malnutrition as a medical condition. But it also insists on something less tangible and sometimes dangerous: bearing witness, or témoignage.
“Our humanitarian action must not be silent,” says MSF. “From the start, our medical teams made a commitment to care for patients as well as to speak out and call attention to the problems driving emergency needs. This is a core element of our response to disasters, both natural and human-made.”
That commitment comes with risks. Most MSF health workers must navigate volatile environments, often recruited from the very communities they serve. They face the same shortages, the same dangers, and the same uncertainty.
And yet, they continue.
“My colleagues are extraordinary people,” Hassan says. “Driven by a commitment to deliver independent, impartial care.”
The greatest challenge, she says, is a lack of support.
“The cost of inaction is enormous,” she says.
Ultimately, hunger in conflict is not just a humanitarian issue. It is a reflection of political choices—about who gets access, who is protected, and whose suffering is allowed to continue.
And in too many places, that suffering is no longer incidental.
It is engineered.
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