Parts of Southern Africa have experienced their lowest rainfall since 1981, while others have endured the destruction of cyclones Idai and Kenneth, causing food insecurity, malnutrition and disease to increase in multiple countries. Despite improvements in Madagascar and Malawi, there are now 9.2 million severely food insecure people in the region and this figure is expected to grow to 12 million at the peak of the lean season (October-March). In Zimbabwe, floods, dry spells and economic downturn have driven rapidly rising hunger, with 2.3 million people in rural areas facing severe food insecurity. In Mozambique, drought, two cyclones and violence in the north have left 1.65 million people severely food insecure, while in Zambia, 1.7 million people are severely food insecure following erratic rains, dry spells, water logging, and false and late starts to the 2018/2019 rainy season. In Eswatini and Lesotho, nearly a quarter of the rural population face Crisis or Emergency food insecurity, while in Angola the drought is having severe consequences, particulary for children. Across the region, drought and floods have increased the likelihood of communicable disease outbreaks. In 2019, there have been cholera outbreaks in Angola, Mozambique, Tanzania and Zimbabwe. Measles outbreaks are ongoing in Angola, the Comoros and Madagascar, and there are outbreaks of hepatitis E in Namibia, dengue fever in Mauritius and Tanzania, and vaccine-derived poliovirus type 2 in Angola. Protection risks, including gender-based violence, have risen due to the multiple shocks impacting already vulnerable communities.