In July, MSF implemented a new preventative strategy aimed at reducing the persistently high number of acute malnutrition cases in Niger.

A mother receives ready-to-use therapeutic food for her child in Madarounfa during an MSF nutrition distribution. © Anthony Bourasseau/MSF

Niamey, September 8, 2010 — Every year, the population of Niger is affected by a nutritional crisis that peaks between May and September. The scale of the crisis in 2010 is particularly worrying. 

In addition to providing treatment for children with severe malnutrition, MSF is distributing ready-to-use supplementary food to more than 143,000 children. These products, containing milk, minerals, and vitamins, are adapted to the nutritional needs of young children. The plan has been worked out with the Government of Niger, the World Food Program (WFP) and UNICEF and the distributions are being implemented in five districts in collaboration with Nigerien organizations. 

“Prevention is about finding the best way of stopping children from becoming severely malnourished year after year,” said Dr. Susan Shepherd, coordinator of MSF’s nutritional working group, “decreasing the medical, logistical, and financial burdens that are created by the treatment of so many sick children.” 

The distribution of food supplements on a large scale this year represents a major positive change in the preventive response to the nutritional emergencies in Niger. However, the recurrent nature of the nutritional crisis in the country calls for these preventive strategies to be integrated into the fight against malnutrition on a more permanent basis.   

MSF aims to work with its local and international partners to define the best product and the most effective long-term strategy to prevent malnutrition among young children in Niger. 

MSF and its national partners BEFEN/ALIMA and FORSANI have admitted more than 77,000 children with severe malnutrition out of the 170,000 who received care in the country since the beginning of the year. In these regions, as well as in Agadez, MSF provides free medical care for young children in primary health care centers and pediatric hospitals.

An MSF staff member measures a child's mid-upper arm circumference at a nutrition program in the Guéra region. © Boris Revollo / MSF

MSF is conducting emergency nutrition interventions in Chad, in the Sahel region, where approximately 10 million people are expected to suffer from food insecurity. Hear more from the latest MSF Frontline Reports Podcast.

Interview with MSF President, Dr. Marie-Pierre Allié 

Dr. Marie-Pierre Allié, president of Doctors Without Borders/Médecins Sans Frontières (MSF), returned recently from a trip to Niger. With another nutritional emergency underway, new preventive approaches are emerging in the struggle against malnutrition. 

Mothers wait to receive ready-to-use therapeutic food at a nutrition program in the district of Guidan Roumdji. © Alessandra Vilas Boas/MSF

What is your analysis of the situation? 

Clearly, Niger is experiencing a serious food and nutritional crisis. Last year’s poor rainfall produced inadequate harvests in a food security context already weakened by a gradual increase in food prices over recent years. 

The most recent data on the country’s nutritional situation showed that rates of childhood malnutrition are above the emergency threshold of 15 percent in many regions of the southern part. In certain areas, such as Maradi, where we work, one child out of five is suffering from acute malnutrition. And four percent of children under 5 [years of age] suffer from the most severe form of malnutrition. 

Some people describe this as a “famine,” saying that this is a “crisis of previously unheard-of proportions.” Is that true?
 

It would be counter-productive to exaggerate. We should be careful about our choice of language. We don’t have to go to extremes to dramatize the situation in order to emphasize that this is a serious situation, nutritional indicators are alarming, and an appropriate response must be organized. Furthermore, we should also put the current situation in perspective with respect to recent years. Although the crisis of 2010 is certainly more serious, it is not radically different than those the country has experienced in the last few years. Unfortunately, we are witnessing recurrent crises that vary only by intensity from year to year. 

Therefore, the key is not to rank them by severity—which would also be extremely complex—but, rather, to emphasize their periodic occurrence. 

Is there a difference between the crises of 2010 and 2005?
 

Yes, in terms of the breadth and quality of the response. Both have changed dramatically since 2005. At that time, response was slow, both because the regime in power was unwilling to acknowledge the problem and because of the lack of effective warning and response mechanisms. MSF sounded the alarm, calling for deployment of international aid and the adoption of new treatment protocols. 

At that time, we heard a lot of talk about “ready-to-use therapeutic foods.”
 

That was the first time these new products had been used on a large scale, allowing us to treat cases of severe malnutrition on an outpatient basis. Thanks to this strategy, MSF’s sections managed to treat 63,000 malnourished children. It had previously been impossible to treat such a large number of children because of the burden (volume and cost) their hospitalization would have represented. Since that time, Nigerien health authorities have adopted these new strategies for treating severe malnutrition, thus increasing the number of children who can be treated. 

However, Nigerien authorities seem to have been less open concerning nutritional issues after 2005.
 

Yes, there’s a certain paradox. President Tandja chose to deny the seriousness of the situation and the significance of the stakes involved in responding appropriately. In 2008, the French section of MSF was forced to leave the country. 

However, some important changes did occur, including new protocols for treating malnutrition, free medical care for children under five, the adoption of new standards for defining severe malnutrition (recommended by the World Health Organization) and, last, local production of ready-to-use therapeutic foods. 

What measures have been adopted to address the crisis of 2010?
 

The new Nigerien authorities began alerting the international community to the seriousness of the situation in March. They organized sales of cereal at low prices and free food distributions. The response plan should also make it possible to treat more than 300,000 severely malnourished children in the country, which is four times more than in 2005. 

In addition, we should emphasize that widespread preventive measures are also part of this approach, including the distribution of complementary foods intended for infants, who constitute the most vulnerable populations. 

Is the response meeting the needs?
 

What we can say for sure is that the response is ambitious and will certainly make it possible to save many children. The response plan has evolved as the situation has changed. Unfortunately, it did not target immediately the areas most affected by childhood malnutrition but instead, gave priority to areas experiencing agricultural production deficits. Here again, the issue is emergency response, which requires considerable resources to treat children who are already severely malnourished. The malnutrition prevention measures that have been implemented are a good way to begin moving beyond this approach and to respond sooner. 

It will be particularly important to make sure that these measures are maintained after the most difficult period winds up and that they are implemented systematically to prevent the recurrent peaks in severe malnutrition that we see every year, from June to October. 

What role is MSF playing in this context?
 

MSF teams are working in the regions that have been the most seriously affected by the crisis: Tahoua, Maradi, Zinder and Agadez. We have strengthened our treatment programs to face the crisis and are now managing 8 nutritional hospitalization centers and approximately 60 outpatient centers, working in conjunction with the Nigerien Ministry of Health. Since January, we have treated approximately 65,000 children and expect to treat a total of 150,000 this year. 

We are also organizing supplemental food distributions for children from six months up to two years, in the areas where we are working. This should allow us to reduce significantly the number of malnourished children during the second part of the season. We also hope to continue these distributions beyond the crisis period, to get ahead of the “hunger gap” of 2011. 

MSF’s French section has returned to Niger. What does that mean?
 

It signals the common willingness for both Nigerien authorities and MSF to resume our joint efforts to address the pediatric and nutritional problems in that country. To do that, we are working with a Nigerien medical NGO, Forsani. We had decided to support the organization after we left in late 2008. In 2009, more than 12,600 severely malnourished children were treated under the joint program in Madarounfa. 

We hope to develop sustainable treatment and preventive programs by working with these young Nigerien doctors, health authorities and other aid actors.

In the last few months, a combination of bad harvests and growing insecurity has resulted in a huge increase in the rates of malnutrition in Southern Sudan. While Doctors Without Borders/Médecins Sans Frontières (MSF) is responding to the crisis, more feeding centers, specialized food, and staff are needed to prevent needless deaths of Sudanese children.

Here, MSF Emergency Coordinator in Southern Sudan Moses Chol explains how MSF is expanding activities so that more nutritional aid will reach the regions that desperately need it.

What is the nutritional situation in Southern Sudan today?

The situation is extremely worrying, especially in the Upper Nile region. Over 800 children are being treated in MSF’s feeding centers in Unity State alone. The annual hunger gap is not entirely to blame for this, as there was a 200 percent increase in the number of children treated as compared to the same period last year.

Why do you think the situation is so bad this year?

There is a combination of factors, but the main one is the scarcity of food. Basically, we are six or eight weeks away from the harvest and there is very little food to be found in the market. The price of the main staple food, sorghum, has more than doubled since last year, resulting in people having to sell capital assets such as goats and cows to buy basic foodstuffs. There are significant gaps in basic healthcare, whereby patients have to walk for several hours to receive the most basic of treatments, which contributes to children getting sick and further weight loss. But of course, the violence and insecurity also make things even worse.

There are some pockets of violence where tribal disputes or more political post-election clashes have happened. Whatever the root of the violence, many families have had to flee their homes and therefore cannot farm their land. This has been a direct impact on the agricultural output and families’ capacities to feed themselves.

We have managed to find some local partners who we have trained and helped with supplies, but there is a real need for more people to expand their interventions in the country to tackle this acute crisis.

How did MSF react to the upsurge in malnutrition?

As we saw the numbers going up, we first made sure that we could deal with the increasing number of patients in our own clinics and feeding centers. In many places, we’re pretty much the only aid organization providing nutritional support. But we also figured that if the situation was bad where we were, it was probably at least as bad in other areas where there was no health actor providing assistance.

When analyzing the origins of our patients in our feeding center in Leer, we found that 15 percent of patients were coming from the capital of Unity State, Bentiu, over 100 kilometers (62 miles) from Leer—this is what led us there.

You were part of the team doing the assessment in Bentiu. What was the situation when you got there?

Bentiu is a big town of about 100,000 inhabitants where 80 percent of the people are unemployed and rely heavily on humanitarian aid. Ironically, during the war, they could count on regular food distributions, but this has stopped with the peace agreement.

Bentiu has a relatively big hospital, but the staff there did not have the capacity to respond to the nutritional emergency. Children are admitted for an array of pediatric conditions, but cannot be treated for malnutrition because the hospital staff have no specialized food for therapeutic feeding.

When we visited the hospital for the first time, they had admitted four children suffering from malnutrition, but two had died. The staff there told us that the only thing they could provide was counseling to the families of the two others. There was a lack of supplies, human resources and training, which meant that starting to treat malnutrition was not even an option.

That’s when MSF decided to intervene?

As we’re already intervening in many parts of Southern Sudan, we tried to encourage the authorities and other organizations to get involved in Bentiu. But there are very few organizations with spare capacity to go beyond their current program areas, and in Bentiu there was no one present in a position to react.

What will MSF do to improve the situation?

Our team has opened two feeding centers in Bentiu hospital. The first one provides intensive care for children who need to be hospitalized and carefully monitored. The second center provides ambulatory feeding care which means that mothers can come with their children to be weighed and measured, and then receive specialized therapeutic food that they can take home to administer, only having to return to the center after a week or two.

Within three days of the feeding centers opening in Bentiu, 28 children were hospitalized and 70 children were enrolled in the ambulatory feeding program.

Once we identify where most of the affected kids are coming from, we may open new ambulatory structures in different areas, but keep referring the kids who are worst off to Bentiu for hospitalization.

In addition to providing lifesaving care to malnourished children in and around Bentiu, the MSF team will focus on training local health staff to treat malnutrition so that the capacity to respond remains even after MSF’s departure.

Can MSF do more?

MSF is already intervening in many parts of Southern Sudan, often as the only organization treating malnutrition. We have managed to find some local partners whom we have trained and helped with supplies, but there is a real need for more people to expand their interventions in the country to tackle this acute crisis.

How long will MSF stay in Bentiu?

That’s not an easy question, but we hope that the nutritional situation will improve after the harvest and that the hospital staff will be able to manage the remaining cases. Our initial plan is to stay for three or four months. We will reassess the needs at that time and we may well have to stay longer if the needs are there.

Throughout Africa’s Sahel region, MSF works to treat and prevent malnutrition during a particularly extreme food and nutrition crisis.