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Increasingly and consecutive climate shocks over the last decade, coupled with economic challenges and poverty, have had a harsh impact on the lives and livelihoods. Repeated droughts and occasional flash floods have further worsened the already extreme climatic condition, causing severe water shortages and increasing the levels of food insecurity and malnutrition as well as disease outbreaks. It is estimated that 98 per cent of people in rural areas suffers from inadequate and sufficiently varied diet, some 6,000 children under age 5 are acutely malnourished, of whom 1,278 are severely malnourished. About 280,000 people (nearly a third of the total population) are in a chronic food insecurity situation, according to the 2018-2022 IPC Chronic Food Insecurity Analysis. The most severely affected areas are the Obock regions in the north, the Ali Sabieh and Dikhil regions in the south, with respectively 30 per cent, 25 per cent and 20 per cent of the rural population at IPC Level 4 (Severe). In the capital and its periphery cirty of Balbala, 15 per cent and 25 per cent respectively are at Level 3 (Moderate), about 113,000 people. The country imports 90 per cent of its food commodities, leaving its population not only highly vulnerable to the climate shocks but also to fluctuations in international food prices.
Conflict, insecurity and extreme hardship in neighbouring countries have driven refugee and migrants influx to Djibouti. The country hosts over 30,000 refugees and asylum seekers (one in 30 Djiboutians), mainly from Somalia and Ethiopia, but also from Eritrea and Yemen. Some 49 per cent of them are children. In addition, over 100,000 migrants (one in 10 Djiboutians), mostly Ethiopian, live in the country, and an additional 300-400 travel through Djibouti on daily basis–often on foot, through perilous and desertic areaswith peaks over Ramadan and towards the end of the year (over 1,000/day).
High populations movements, combined with the poor access to water, sanitation and hygiene, increase the risk of disease outbreaks. Recurring water-borne diseases, including acute watery diarrhoea, are endemic, affecting the wjole whole population.
Despite its sustained growth since the 1990s, Djibouti is still affected by poverty and inequality. With a poorly diversified economy and little resilience to outside shocks, 35 per cent of the population lives in poverty, of whom 21 per cent are in extreme poverty. The situation is worse in rural areas, with 62 per cent of people living in poverty.

[Updated in September 2019]