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Children with jutting ribs and swelling bellies, too weak to cry, have become symbols of the most devastating conflicts in the world.

Images of starved youngsters in countries pushed to the brink of famine by bombs and blockades have long been shared in efforts to provoke decisive action against the perpetrators.

Now a leading charity has estimated the conflicts, which have no end in sight, will kill more than half a million children before the end of the year.

Research by Save the Children has estimated 4.5 million children under the age of five will need treatment for life-threatening malnutrition this year - an increase of almost 20 percent since 2016.

Two in three of these severely malnourished children are set to miss out on vital treatment, with 590,000 expected to die as a result - more than the population of Manchester.

That's an average of 1,600 children under the age of five dying from extreme hunger every day, or one child every minute. 

Using starvation as a weapon of war has become the new normal, with devastating consequences for children.

The numbers come as humanitarian agencies grapple with chronic funding shortfalls to many UN emergency appeals for conflict zones. Warring parties are also acting in defiance of international humanitarian law by preventing supplies from reaching children in need.

"Using starvation as a weapon of war has become the new normal, with devastating consequences for children," CEO of Save the Children Kevin Watkins said. "From Yemen to South Sudan, the failure to protect children from hunger is putting lives at risk."

Symptoms of severe acute malnutrition - the most extreme and dangerous form of undernutrition - include jutting ribs and loose skin, with visible wasting of body tissue. Swelling in the ankles, feet and belly as blood vessels leak fluid under the skin, are other symptons.

With immune systems too weak to fight illnesses, severely malnourished children are far more likely to contract and die of diseases like pneumonia, cholera and malaria than healthy children. Even where children survive, the effects of malnutrition can be life-long and affect physical and mental development.

In Yemen, Save the Children has estimated some 35,000 malnourished children will die this year, where obstructions to deliveries of food and medicine by all sides - including a coalition of Arab states backed and armed by the UK and US - have exacerbated the situation.

Read more: This is what collapsing systems look like in Yemen

In June the Saudi-led coalition launched an assault on the country's main port of Hodeida, where 75 percent of vital supplies of food, fuel and aid arrive.

After more than three years of war, a quarter of children under-the-age of five living in the city were malnourished even before the assault began.

Lucky to survive, twice

In one of thousands of cases, one-year-old Nusair* was lucky to survive. He was suffering from a deadly combination of severe malnutrition and diarrhoea when he reached a health facility supported by Save the Children.

His mother Suad* had braved landmines, checkpoints and airstrikes to get him there.

Nusair's mother Suad braved landmines and checkpoints to get him to hospital [Save the Children]

Nusair faced death a second time during his treatment when an air strike hit near the hospital he was attending. Dozens died in the blast - but he and his mother survived.

"My dream is simple - the war must stop so we can live in peace," his mother said. "The casualties of this war are ordinary people, civilians."

In Syria, the regime of President Bashar al-Assad appears to have defied warnings of a humanitarian catastrophe and looks set to launch a full-scale assault on the last rebel-held bastion of Idlib.

Save the Children estimates more than 11,000 children will go untreated for severe acute malnutrition, leading to the deaths of more than 2,300 children aged under-five.

In South Sudan, more than 18,000 children could die as a result of the portracted conflict.

Save the Children is to help aid workers and local health partners reach more children through treatment and feeding programmes in war zones across the world. It takes 150 sachets of enriched peanut paste - at a cost of £30 - to save a malnourished child's life and help them recover, the charity said.

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