First food distribution in Dan Issa, Niger

© Anne Yzebe/MSF Click for large view The size of the crowd matched the hopes brought by the free food aid. At 6 a.m., hundreds of mothers and children were waiting patiently in front of the primary school. By 10 a.m., thousands of people were pressing against the barriers.

In addition to the MSF treatment program for children suffering from severe malnutrition, the organisation has also made the decision to provide food aid to 20,000 to 25,000 children in the Maradi region suffering from moderate malnutrition. The first distribution finally took place on Saturday, July 23, following complex preparations.

"I expected that it would be hard, but not this hard," says Christian Revert, an MSF logistician, with surprise. The first day of registration for the targeted food distribution in Dan Issa, a village southwest of Maradi, did not end until night. The size of the crowd matched the hopes brought by the free food aid. At 6 a.m., hundreds of mothers and children were waiting patiently in front of the primary school. By 10 a.m., thousands of people were pressing against the barriers, sometimes knocking them over.

During registration day, children under 5 with moderate malnutrition left with a yellow band around their ankle. Several days later, this identification would entitle them to a food ration. MSF's experience knows the dangers that crowds pose during food distributions and measures were put in place to bring a greater level of safety. Ropes marked off the circuit leading to the aid and the children passed through, village by village. Village leaders were responsible for maintaining calm.

© Anne Yzebe/MSF Click for large view A yardstick is used to identify children below 65 centimeters in height. Those children, malnourished or not, will receive a food distribution and a bracelet.

A yellow bracelet

The circuit began with a wooden frame. A bar was set one metre high and the children able to pass underneath it were allowed to continue. The others stopped there. They were older than 5 and less vulnerable. Most had a younger brother or sister who continued on through the process. The older ones would also receive food, which would come through the aid provided to the youngest family member. Further on, a yardstick was used to identify children below 65 centimeters in height. Those children, malnourished or not, would receive a food distribution and a bracelet.

All those measuring between 65-100 centimeters continued to the next step, which involved evaluating the degree of malnutrition by placing a colored plastic paper MUAC (middle upper arm circumference) band around the top of their arm. The thinner the arm, the tighter the band. The arm circumference corresponded to a green, yellow, orange or red strip. A child whose measurement fell in the red zone was suffering from severe malnutrition.

© Anne Yzebe/MSF Click for large view Children whose MUAC measure was in the orange zone - moderate malnutrition - would receive a yellow bracelet.

The child would be admitted into the MSF treatment program and either hospitalized or monitored at home, depending on the state of his health (see the article on treatment of severe malnutrition). Children whose MUAC measure was in the orange zone - moderate malnutrition - would receive a yellow bracelet. Those with yellow or green MUAC measures returned home after receiving zinc to prevent diarrhea.

As the children under 5 continued, MSF teams also watched for sick youngsters, and sent them to the hospital or the health centre. These facilities have been supplied with medicines and MSF has entered into agreements with the Ministry of Health authorities allowing children under 5 to be treated there at no cost.

"I've never seen a day like this," sighed Anne Secondo, an MSF logistician, who returned after nightfall. That first day, she had seen 3,000 children pass through - more than twice the expected number. And that was just the beginning.

Over 7,000 children identifed as malnourished

The number of children who arrived over three days of registration at six sites totaled 26,444. According to estimates, this represents all children under 5 in the region. Of those, 7,186 received a yellow bracelet and were eligible for a monthly food ration over a three-month period. The teams also identified nearly 200 cases of severe malnutrition and sent 681 sick children to a health centre for care.

© Anne Yzebe/MSF Click for large view Each mother was given a 25 kg sack of Unimix, a flour enriched with vitamins and minerals. The sack was often put directly on her head where she would balance her load for the walk home. With a four litre container of oil in one hand, a large bottle of water in the other, the sack of flour on her head and a child tied on her back, each one left the distribution site.

Mothers laden with flour, oil and their malnourished child

On Saturday, July 23, the day of the first food distribution, thousands of mothers showed up again to wait.

Using a loudspeaker, Christophe Revert reminded them that only children wearing a yellow bracelet could enter and suggested that the other mothers return home. But sometimes it is too hard to give up and the crowd remained dense. Despite the frustration for the people who received nothing, the distribution took place calmly and without incident.

The mothers lined up so that the team could check the bracelets. They then moved ahead toward the nutritional assistants, who explained how to use the flour and oil they would receive. Next, the child's yellow bracelet was cut off, replaced by a blue one, confirming eligibility for the next distribution in one month.

And then, finally, the long-awaited moment. Each mother was given a 25 kg sack of Unimix, a flour enriched with vitamins and minerals. The sack was often put directly on her head where she would balance her load for the walk home. With a four litre container of oil in one hand, a large bottle of water in the other, the sack of flour on her head and a child tied on her back, each one left the distribution site. The children watched as hundreds of mothers filed off, laden with food.

The MSF team had to quickly prepare for the next effort - a new registration process and new distribution in another area. In all, MSF expects to distribute food rations to 25,000 children across three districts south of Maradi, once a month for three months.

This aid totals 1,875 tons of Unimix and 375,000 litres of oil. However this represents only a fraction of the aid that Niger needs. MSF's efforts can satisfy only a part of it. It is essential that other aid actors become involved.