Niamey, Niger, 1 July 2010 – A crisis is brewing in the West African state of Niger the magnitude of which stands to surpass that in Haiti if left unchecked. Almost 400,000 children are in danger of severe sickness and death as a result of a prolonged food shortage. Another 2.1 million children are at high risk of following along the same path.
The current food crisis in Niger - sparked by the worse drought since 1984 – is reducing children and animals to mere sacks of bones. In desperation, some villagers in this country of subsistence-farming have turned to “survival foods” – grass and leaves.
Villagers in Gazourawa, about 400km east of the capital Niamey, say they have no option but to eat leaves so bitter that the animals steer clear of this tree that locals refer to as aguwa.
“We are farmers and we also keep some animals” says Alicha Manzo, 35, as she heads out to the field in search of Aguwa plant. “We grow millet, sorghum, nuts and cowpeas but last year’s harvests were poor and we have no food remaining from that harvest”.
Six of her children join her in her search for the Aguwa plant, as do other neighbours Amina Chaibou, 27, and Alicha Abdou, 47 from the village. There are about 70 families in currently using this “survival food” daily during the hard times in Gazourawa.
“We have to be very careful with the milk from the stems,” Alicha explains as they pick the leaves, “if it gets into your eyes you will go blind”.
Her husband has gone to Matameye, 120km away in neighbouring Zinder region, to find work. He works as a porter delivering people’s shopping home on foot. He has no car or cart.
It takes about an hour to pick the leaves and return to the village. Alicha, her children and neighbours wash the crop thoroughly, the boil it, changing the water four times.
After it simmers, one woman digs in, shoving a handful into her mouth. Its bitter and according to the Chief of Medicine for the District of Matameye, Dr Adamou Amadou, the leaves are dangerous.
“They contain toxins,” he says in his office at the Matameye CRENI (a paediatric hospital for children suffering severe, acute malnutrition with medical complications), “People down through the generations know this. To reduce the toxicity, you need to soak it for several days, changing the water several times before cooking.”
This region of Tahoua is among the five regions where the food crisis is critical. The other three regions in the country – including the capital Niamey – are classified as “serious”.
Until a few weeks ago, aid agencies believed that it was the regions of Zinder and Maradi that were the most severely affected with others at risk.
UNICEF, the world’s leading children’s organisation, has supplied all the clinics in this vast country with sufficient therapeutic foods, anti-malaria, anti-biotic, and anti-anaemia medicines and vitamin supplements to treat a caseload of an estimated 378,000 severely malnourished children.
Together with the World Food Programme they devised a plan to provide protein rich and fortified food to about 500,000 children under two years old in the surrounding regions considered “at risk” as a precautionary measure to nip malnutrition in the bud.
These projections were based on a 2009 national nutrition survey.
However, in the last week, this has all changed.
The 2010 survey was released, confirming anecdotal information from field staff that the situation has worsened considerably. The country is now in an emergency with 2.5 million children now in need of emergency food aid.
“The emergency threshold has been largely exceeded, the children are going through an extremely difficult time and we are very concerned,” says UNICEF’s Director in Niger, Guido Cornale who is a public health doctor by profession.
“We have to reinforce immediately our interventions to limit diseases and loss of human life. An acceleration of preventive and curative actions for malnourished children is ongoing, donors support is crucial at this stage.”
National figures show that since mid-May more than 1,000 children are being admitted to therapeutic feeding centres for malnutrition daily.
At the Madarounfa CRENI in the Maradi Region – one of the largest in the country - Dr Moussa Laouali, Deputy Chief of Medicine of the district says that there has been a 70% increase between January and May this year compared to the same period last year. There has also been a 41% rise in deaths of children under 5.
Prolonged periods of an unbalanced diet leads to malnutrition which initially is moderate. But continued deprivation of proper food and it leads to severe malnutrition. Left unchecked medical complications set in.
The medical complications differ from region to region. In Maradrounfa, children were suffering from malaria, diarrhoea or respiratory infection.
One child, 10-month old Ibrahim Awal, is unlikely to live to see his second birthday. He has developed fluid on the brain.
“We installed a tube to drain the fluid,” Dr Ousmane Hamissou explains, “but he will die if he does not get the necessary surgery and medication.”
This treatment is not available at this centre. Ibrahim has been stabilised. His severe malnutrition is being treated and he will be discharged in a week’s time and sent to a CRENAS (a paediatric out-patient clinic for severe, acute malnourished children without medical complications).
“He’s been in and out of hospital and has been sick a lot. My husband and I spent all our money on doctors, we have no more,” said his mother Mariam, 25.
She had four children but two died. She will have to bury her third child sometime over the next year. She’s expressionless. Resigned to her fate of having to give up yet another child.
“We are farmers and our crops have failed. There is little to eat and Ibrahim is sick again. My neighbour’s child was also sick and he got better after coming to this hospital, so I decided to bring him here too hoping they can make him better,” she says.
This food crisis was easy to forecast, aid agencies say, because of the poor harvests in October 2009.
Eight out of 10 people live in rural areas and are subsistence-farmers. They eat what they grow and sell surpluses to buy non-food items such as clothing, household goods, building materials, and equipment.
They plant at the start of the rainy season in June and reap at the end of the season in October. This period is called the lean season, when food is in short supply as the crops are growing. It calls for belt-tightening and Nigeriens deal with it accordingly. This year the lean season started in March, when supplies totally ran out sparking a food crisis.
When the harvests failed last year, it was obvious to everyone that problems were on the horizon. The government, however, did not accept this nor did they speak about it. This worried aid agencies.
It was not until February 2010 that the government finally admitted there was a problem. It was a new military junta which overthrew the government of President Mamadou Tandja. The junta which is called the Supreme Council for the Restoration of Democracy worked with the United Nations to issue an emergency appeal for help in April.
The deputy chief of medicine for Madarounfa, says they saw the problems coming.
“When we saw that the harvests last year were poor, we knew that trouble was on the horizon,” says Dr Moussa Laouali.
“We took measures to enhance our capacity in anticipation of an increase in cases. UNICEF provided additional beds and two large tents to this CRENI. We trained 38 additional people to detect and treat severe malnutrition in the CRENAS.
Dr Laouali says that there’s been a 70% increase in admissions for January to May. The death rate has increased by 41% for children under five.
The story is similar at CRENIs around this vast country.
In Dakoro, the CRENI sees another type of medical complication – oedema. Children are swollen as a result of retention of interstitial fluids, symptoms pointing to more serious medical issues involving the heart, liver and kidneys.
Children here are severely malnourished. Some weight less than a sack of potatoes.
Hamza Mahamadou, seven months old, was admitted 12 days ago. He had breathing difficulty and diarrhoea but those are symptoms of bigger problems. At his age, he ought to be 7-8kgs but he’s 4.4kgs. He is severely malnourished and will die without treatment.
Treating severe malnutrition is simple and cheap. UNICEF produces a high protein peanut paste named Plumpy’Nut. At 35p per day for a diet of Plumpy’Nut, Hamza will fully recover in about four weeks. However, his respiratory tract infection needs to be treated first.
Four beds away is Ai Soiley, also severely malnourished. His grandmother accompanies him. His mother just gave birth and is at home. Ai looks like a six-month old child but he is two years old. He has a bad rash around his waist which looks as though he had been scalded. The doctor says, it’s not a burn. It is complication from severe malnutrition.
His grandmother brought him here not for malnutrition but because he had diarrhoea for the last month.
The intensive care unit of this field hospital is also filled with newborn babies up to a month-old, some weighed only 1.25kg. These are premature babies. They are full term. The doctor says they are malnourished because the mothers are also malnourished – though they don’t look it – and cannot produce breast milk. Both are kept and treated here. They are also taught about breastfeeding, and proper hygiene and sanitation.
About 50km north of Dakoro is the village of Gadabedji which is the site of a huge animal reservation. It is regarded as the last grazing outpost for animals. When pastures around the country are depleted, animals are brought here but there is little grazing land left here.
Ibrahim Tonga was born here, as was his father and his father. He rears animals – cows, sheep and goats. The occupation is passed down through the generations. It is the life of his people - the Touaregue.
He can’t bear to see the physical condition of his nine children, he says. They are withering away before his eyes. He’s is doing everything that he can for them but it is not enough.
“If you see my children when times were good and then see them now when things are bad, you will cry,” the 50-year-old says.
“They are always sick, I cannot afford sufficient food for them. They know there is a crisis and not enough to eat.”
“Yesterday, I came out to the pasture and saw many of my animals dying. I dropped to the ground and cried,” he recalls.
There are dead animals all around. One goat is still breathing but too weak to even bleat. It will be dead before sunset. On the road to this place there were dead animals – oxen and cows. There was even a dead camel.
Ten minutes away there are animal traders slaughtering dying animals, cooking and bagging their meat to export to neighbouring Nigeria less than 100km away. They leave behind graveyards of bones.
“I sold my dying animals to these men. I earned CFA 70,000 (US$134). Ordinarily, these animals would have fetched CFA 400,000 (US$767),” Ibrahim says.
With the 2010 survey, aid agencies regrouped and discussed the problems. With 2.5 million children now at risk and some agencies short on cash, UNICEF which leads the nutritional emergency response among international agencies operating in the country has adopted a multi-prong approach.
There are 900,000 “at risk” children under two years in need of emergency food aid. There are 1.2 million who are moderately malnourished and there are about 400,000 who are severely malnourished.
The national death rates are not available because of a change in the method of data collection. However at Madarounfa – one of the largest field hospitals – the death rate up to the end of May is 8.4% of total admissions. It is encouraging because the death rate here for the same period last year was 13.78%. Dr Laouali says it is because they spotted the crisis and increased staff and medical supplies in preparation for the influx of cases.
UNICEF says that their multi-prong approach at the national level is to increase staff and medical supplies at every CRENAS for severe and acute malnourished children. This has already been done. They have provided additional tents and beds. All CRENAS are adequately stocked with therapeutic foods and medicine. They have hired eight nurses which are in training. CRENAS are opening seven days a week as opposed to just one day last year. In addition, UNICEF has agreed to pay the salaries of staff at seven CRENAS which were being closed because the international NGO which funded them had run out of money.
The World Food Programme (WFP) usually provides food for moderately malnourished children but funding shortfalls are affecting their operation. UNICEF’s Director Guido Cornale says an agreement has been reached with their sister agency for UNICEF to assist in providing emergency food for the 1.2 million moderately malnourished children.
WFP and UNICEF also teamed up to provide blanket feed to 500,000 children under two years old who live in vulnerable areas. This food was being provided for four months – May to August. They’ve agreed to extend this to December 31 and expand coverage to 900,000 children.
Finally, UNICEF is also examining the merits of a cash-transfer programme to replace the blanket feeding programme.
In this programme paid for by UNICEF and WFP, local NGOs distribute a corn soya blend of sugar and meal together with oil. This means dealing with purchases, importation, transportation, management, and distribution.
Cornale argues that giving cash eliminates the logistics issues and its costs freeing up more money to help these people.
Niger is a landlocked country so the shipments arrive at the Port of Cotonou, Benin and then trucked more than 1000km over land just to the capital – an expensive method. Then it still had to be stored, broken up and distributed to villages more than 1000 km away.
When UNICEF appealed for US$22 million in emergency aid in April it was oversubscribed by US$2 million. With the worsening of the food crisis and the multi-prong approach agreed, the bill has moved from US$22 million to US$147 million which the agency will soon be appealing to the world through the United Nations for help.