In 2019, many more people needed humanitarian assistance than we had forecast, largely because of conflicts and extreme climate events. Donors provided a record $16 billion for inter-agency appeals between January and November 2019. Compliance with international law is declining. Armed conflicts are killing and maiming a record number of children, forcing them to flee their homes. They are becoming a lost generation. Women and girls are at higher risk of sexual and gender-based violence. One in five people living in conflict areas has a mental health condition.Highly violent conflicts are causing widespread hunger, displacement, death and destruction around the world. They are taking a heavy toll on civilians, who account for 90 per cent of the casualties when explosive weapons are used in populated areas. There were 791 attacks against health workers and health-care facilities in the first nine months of 2019, resulting in 171 deaths. In 2018, 131 aid workers were killed and 130 were kidnapped in 400 attacks. Attacks against health and aid workers are putting millions of people at risk by denying them care and aid.