People fleeing conflicts in Central African Republic and South Sudan are growing increasingly sick and hungry with children particularly at risk, United Nations aid agencies said on Tuesday.
Among the latest deaths were 15 malnourished children who "died before they could be saved" at the weekend, having crossed from Central African Republic into Cameroon, said Melissa Fleming, spokeswoman for the UN refugee agency UNHCR.
"I think 'tip of the iceberg' is a very appropriate way of putting it," UNICEF spokesman Patrick McCormick told a news briefing in Geneva, referring to the 15 children.
Violence in Central African Republic and neighbouring South Sudan has displaced about 1.8 million people across the region.
"We're really noticing a trend in all refugees that they're in very poor physical shape. Some are suffering from malaria, diarrhoea, respiratory infections," Fleming said.
"Many have been hiding in the bush for up to even one year in the Central African Republic, which has significantly impacted their state of health. Also, very disturbingly, many children up to the age of 5 are showing varying degrees of malnourishment."
Fleming said the poor state of health of the 15 children who died in Cameroon was "an indication of what's probably worse inside the country".
Many of those fleeing from South Sudan into Ethiopia are also malnourished. UNHCR said medical screening showed 11.1 percent were suffering from severe acute malnutrition and another 16.6 percent from moderate acute malnutrition.
The World Health Organization says that the fatality rate for under-5s suffering from severe acute malnutrition typically ranges from 30 percent to 50 percent.
Central African Republic, a former French colony, has been torn by inter-communal violence since mainly Muslim rebels seized power a year ago and Christian militia exacted reprisals against the Muslim minority.
In South Sudan, a power struggle between the president and his deputy whom he dismissed last July triggered fighting that has killed thousands in the past few months. Despite a ceasefire Jan 23, the violence is worsening, McCormick said.
"South Sudan's dream, the newest country in the world, risks becoming a nightmare for the country's children," he said.
The UN humanitarian appeal for South Sudan is more than $1 billion short of a target of $1.27 billion by June. A UN strategic response plan for Central African Republic has received only $112 million of $551 million needed this year.