**Background:** Malnutrition is a major cause of mortality and morbidity globally, contributing to approximately 45% of all deaths in children under five, predominantly in low- and middle-income countries. Globally, about 47 million (6.9%) under-five children are wasted, 144 million (21.3%) are stunted, and 38.3 million (5.6%) are overweight or obese. Sudan faces a protracted humanitarian crisis driven by social conflicts, macroeconomic instability, COVID-19, flooding, and desert locusts, leaving 16% (7.1 million) of the population in crisis phase (phase 3 and 4). Sudan has made no progress toward stunting and wasting targets, with 38.2% and 16.3% of children under five affected, respectively—both higher than the Africa regional average. Approximately 8.6 million people lack adequate healthcare, 3.3 million are acutely malnourished, over half a million children suffer from severe acute malnutrition (SAM), and 2.2 million children require treatment for moderate acute malnutrition (MAM). Community-based management of acute malnutrition (CMAM) has emerged as an alternative to traditional facility-based approaches, comprising four key elements: community mobilization, supplementary feeding programmes (SFP) for MAM, outpatient therapeutic programmes (OTP) for uncomplicated SAM, and stabilization centers for complicated SAM. CMAM uses simple screening tools (MUAC tape), home treatment with ready-to-use therapeutic foods (RUTF), and a simple classification system. South Kordofan has an estimated population of 2.5 million, with over 200,000 people displaced by conflict and extensive infrastructure destruction. The global prevalence of underweight and wasting among children under five in this region is 26.1% and 7.8%, respectively.
**Methods:** This is a descriptive case study based on secondary data from the South Kordofan State Ministry of Health (SMOH), the Federal Ministry of Health (FMOH), and international non-governmental organizations (INGOs) including UN-OCHA. The paper reviews the current status of CMAM implementation across South Kordofan's 14 localities, where health and nutrition services are implemented by locality health departments (LHDs) with INGO support. The authors synthesized data on health facility capacity, OTP and TSFP coverage, stabilization center availability, and operational challenges.
**Key Results:** South Kordofan has 230 health facilities, of which only 140 provide OTP for SAM cases without medical complications. Of these 140 OTP centers, 28.6% (40) are operated by SMOH and the remainder by INGOs. Among the 140 OTP centers, 73.6% (103) also provide targeted supplementary feeding programmes (TSFP) for MAM; of these 103 TSFP centers, 41.7% (43) are SMOH-operated. Only 11 of the 14 localities have stabilization centers for complicated SAM cases, and only 63.6% (7) of these are SMOH-operated. Community mobilization and screening are primarily supported by INGOs. Key challenges identified include: (1) INGO dependency and limited SMOH financial resources, threatening programme sustainability; (2) shortage and low motivation of nutrition officers due to low salaries (SMOH nutritionists earn 27–40 USD per month, volunteers earn 16–24 USD per month, often paid late); (3) insecurity from periodic tribal conflicts in localities such as Abujubaiha, Talodi, Rashad, and AbuKarshola, impeding movement and service delivery; (4) seasonal floods rendering roads impassable, causing stock-outs of nutrition and medical supplies and disrupting monitoring and community-based activities; (5) poor referral systems with limited ambulance availability and poor road networks, leading to high transport costs, delays, and gaps in continuity of care; (6) lack of operational and implementation research data due to INGOs working in isolation without data sharing, compounded by poor internet, limited phone network coverage, poor roads, and limited trained staff; and (7) limited integration of nutrition services into other health services due to insufficient trained staff, resulting in delayed case identification.
**Clinical Implications:** The paper underscores that effective CMAM implementation in conflict-affected settings requires multi-sectoral integration, strong political commitment, and adequate resource allocation. Recommendations include: advocacy for increased SMOH funding and programme-based budgeting; strengthening human resources for health (HRH) to address staffing shortages and retention; integrating conflict perspectives into programme design; constructing large warehouses for pre-positioning supplies before rainy seasons and exploring in-country RUTF production; establishing stabilization centers in every locality and strengthening referral systems; investing in infrastructure (roads, telecommunications) and health information systems for timely data reporting; initiating operational research initiatives; and integrating nutrition training (MUAC screening, IYCF practices) into all health worker curricula. The authors emphasize the need for joint learning platforms across nutrition, WASH, and health sectors to share lessons and best practices.