Forty-eight million people in West and Central Africa face acute food insecurity in the coming months, a 10-year high spurred by insecurity, climate shocks, COVID-19 and high prices, United Nations’ humanitarian agencies warned on Tuesday.

West and Central Africa has faced increasing risks caused by higher temperatures and erratic rainfall. War in Ukraine has contributed to food and fertilizer shortages in one of the world’s poorest regions.

The number of people without regular access to safe and nutritious food is projected to hit 48 million during the June-August lean season, according to a regional food security analysis presented by the U.N.’s World Food Programme, humanitarian agency OCHA, Food and Agriculture Organization and children’s agency UNICEF.

That is driven in part by the plight of countries in the semi-arid Sahel region south of the Sahara Desert including Mali and Burkina Faso which are battling an Islamist insurgency that has killed thousands and displaced around 2.5 million.

A record 45,000 people in the Sahel are expected to face catastrophic hunger, a level just short of famine, according to the statement.

“Growing insecurity and conflict means vulnerability is increasing in the region, and it is getting harder to help communities in isolated areas,” said UNICEF’s West and Central Africa Director Marie-Pierre Poirier.

Around 16.5 million children under five are set to face acute malnutrition this year, according to the analysis, which said the area impacted by food shortages would likely spread long term.

The region’s dependence on imports has made it vulnerable to high global inflation rates even though many parts of West Africa saw improved rainfall in 2022 and an increase in cereal production.

“It is time for action to boost agricultural production to achieve food sovereignty in our region,” said Robert Guei, the FAO’s Sub-regional Coordinator for West Africa.