In emergency situations such as conflict and internal displacement, young children and women who are pregnant or breastfeeding are the most vulnerable to severe acute malnutrition. Severe acute malnutrition (SAM) mainly involves macronutrient deficiency, which means that a person is not getting enough essential nutrients in the form of carbohydrates, protein, and fat.92 A person with SAM is at risk of dying without immediate treatment. SAM is frequently associated with medical complications due to its impact on metabolism and the immune system. These can include infections, severe anaemia, diarrhoea and dehydration, delayed wound healing, and hypothermia, among others. Children in particular are at the highest risk of dying from starvation, with SAM a major cause of morbidity and mortality in children globally.93 Severe acute malnutrition encompasses a spectrum that has kwashiorkor at one end and marasmus at the other. Kwashiorkor in children typically presents as a distended belly and swollen legs or feet, while marasmus presents as severe muscle wasting and a skeletal appearance. 94 SAM in children is usually diagnosed via mid-upper arm circumference, which measures the degree of muscle wasting. A MUAC of less than 115 mm in children aged 6 - 60 months (up to 5 years old) indicates SAM and significant mortality risk.95 Conditions of life in northern Rakhine State Yet another far-reaching impact of the regime’s humanitarian access restrictions is that aid workers cannot conduct MUAC screening to assess levels of severe acute malnutrition among Rohingya children in northern Rakhine State or mobilise the resources which are essential for saving lives, such as ready-to-use therapeutic food (RUTF). In April and May 2025, BROUK conducted telephone surveys with Rohingya respondents in villages in Buthidaung and Maungdaw townships. This research was extremely difficult given the telecommunications challenges in these townships, and the surveys were necessarily limited in scope.96 BROUK’s researchers collected information about the three pillars of food security - food access, food availability, and food use97 - as well as availability and adequacy of drinking water and sanitation facilities. They also asked respondents about public health challenges, such as outbreaks of diarrhoea, and signs of severe acute malnutrition (kwashiorkor and marasmus) among children. Buthidaung township BROUK researchers spoke with respondents in nine villages in Buthidaung township, with a total population of over 9,500. On average, 47 percent of the population were IDPs, and almost all had been displaced for over a year. 92 Sarah Bunker & Jyotsna Pandey, ‘Educational Case: Understanding Kwashiorkor and Marasmus: Disease Mechanisms and Pathologic Consequences’, in Academic Pathology Vol 8 (2021) available at <https://www.sciencedirect.com/science/article/pii/S2374289521003316> accessed 27 May 2025. 93 WHO, ‘Malnutrition: Emergencies and disasters’ (20 January 2020) available at <https://www.who.int/newsroom/questions-and-answers/item/malnutrition-emergencies-and-disasters>; MSF, ‘MSF Medical Guidelines: Severe Acute Malnutrition’ (February 2024) available at <https://medicalguidelines.msf.org/en/viewport/CG/english/severe-acutemalnutrition-16689141.html#section-target-10> accessed 27 May 2025. 94 Bunker & Pandey, op. cit. 95 MSF (February 2024) op. cit. 96 Due to the security risks for all involved and the risk of reprisal attacks, BROUK is not publicly identifying these villages but will share the data collected with key international stakeholders as part of efforts to advocate for urgent international humanitarian assistance for Rohingya in northern Rakhine State. 97 See for example, UNHCR, ‘Emergency Handbook: Food security needs assessment’ (29 May 2024) available at <https://emergency.unhcr.org/emergency-assistance/food-security/food-security-needs-assessment> accessed 24 May 2025. 18