Gendered Barriers to Health and Nutrition Resilience among Female-Headed Households in Conflict-Affected Darfur: Evidence from a Mixed-Methods Study

Female-headed households (FHHs) in conflict-affected Darfur, Sudan, face intersecting vulnerabilities across food security, health access, psychosocial wellbeing, and community participation. This study assesses the impact of a five-year humanitarian program Resilience Towards Development (2018–2023) using a longitudinal mixed-methods approach. Quantitative data from 2,035 households and qualitative insights from 36 focus group discussions, 20 key informant interviews, and 5 participatory rural appraisals were analyzed. Indicators included household hunger, child dietary diversity, maternal health access, and resilience capacity, disaggregated by gender and household type. Findings show significant improvement in financial access among FHHs (15.1% to 28.0%, p < 0.01), but deterioration in key health and nutrition indicators. Child dietary diversity declined from 12.8% to 6.8%, and acute hunger rose sharply from 4.1% to 22.6% among FHHs (p < 0.01). Psychosocial distress remained high, and only 9.8% of health governance committee members were women. Gains in absorptive resilience were modest, while adaptive and transformative capacities stagnated. These outcomes expose the limitations of gender-neutral programming in fragile settings. The study calls for gender-transformative strategies that prioritize FHHs through inclusive service design, targeted nutrition and mental health support, and women-led governance models. Lessons from Darfur offer transferable insights for humanitarian responses in conflict-affected regions across Eastern Africa.