Extended families are caring for 90 percent of all orphans in Africa
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The number of children orphaned through Aids is set to nearly double in seven years, the UN Children's Fund warns.
Aids has left more than 11 million African children under 15 without at least one parent, and 20 million are expected to be orphans by 2010.
Unicef chief Carol Bellamy said: "We need to move beyond feeling beleaguered to feeling outraged by the unacceptable suffering of children."
Unicef says financial help must be offered to support communities.
Overwhelmed
Extended families are caring for 90% of all orphans, the organisation says in its report Africa's Orphaned Generations.
But it warns they are already overstressed and often overwhelmed, and face ever-greater burdens as the number of children without parents spirals upward.
Children and young people in an HIV/Aids-affected household begin to suffer even before a carer has died.
Household income plummets and many children are forced to drop out of schooling to care for a sick parent or to earn money, Unicef says.
Vulnerable families
Depression and alienation are common and survival strategies, such as eating less and selling assets, intensify the vulnerability of households.
The countries facing the biggest increases in the number of orphans are Botswana, Lesotho and Swaziland.
Many of the most severely affected countries in sub-Saharan Africa have no national policies to cope with the situation, Ms Bellamy said.
"Offering children free basic education, giving them safe... options for earning a living, and providing families with financial and other assistance can mean many orphans... are able to remain with their families," she said.
She added: "The future of Africa depends upon it."