Treating malnourished children in Darfur, Sudan

© Click image for large view In recent months, more than 80,000 displaced persons have gathered in camps set up in or around the city of El Genina in the West Darfur region of Sudan. They are living — or, rather, surviving — in extremely precarious conditions. One of the major camps is known as Ardamata and it is home to nearly 20,000 displaced Sudanese. Hundreds of tiny shelters, built of roughly assembled scraps of wood, bits of torn canvas, grass and debris are scattered across the camp. Some have a roof covered with plastic sheeting distributed by the nongovernmental organizations (NGOs) working here, providing the displaced persons slightly more secure shelter. But most are open to the elements. During the day, the blazing sun filters through. At night, torrential rains pour in and will last all summer. The nighttime rains feed the grass. A few donkeys graze on the thin green growth blanketing the brick red earth. Children run along the pathways and women work the soil on small plots of land here and there. But this appearance of a "normal" life in the camps — one that many would like to see presented as reality — is only an illusion. The crowds at Médecins Sans Frontierès' (MSF) recently opened feeding center are a reminder that the displaced persons are not ready to resume a normal life. The story of Radoan, a one year-old, and his mother, Mariam Radoan, a severely malnourished child, will be treated in MSF's outpatient therapeutic feeding center in Ardamata camp in El Genina, a city in the Darfur region of western Sudan. His mother is slightly reassured. She describes the seven months of life under extremely precarious conditions and speaks of her fears for the future. Radoan, barely a year old and a bit timid, cuddles in his mother's arms. He is severely malnourished, with a weight/height ratio barely 75 percent of normal. But he eagerly eats the bits of food from the plumpy nut sachet that his mother places in the palm of his hand. He does not have a fever or diarrhea, so he will be able to leave with his mother. He will return every three days until his weight improves. Mariam seems to be comforted. The doctor has reassured her about her child's health. But Mariam wants to talk. She describes her life in Armadata camp, where she has lived for seven months; the daily search for food and water; the World Food Program (WFP) registration cards that would have enabled her to benefit from a few food distributions but that she did not obtain; the often fruitless search for work in town; the days without food; the rain that demolishes her hut every night; and the violence she has experienced and that remains ever-present. "We do not want to go back home," she says, fearfully. "We don't have anything anymore and we are frightened. We will go back only if all the displaced persons leave at the same time." One child in four is malnourished A nutritional survey conducted in Ardamata camp revealed a high rate of malnutrition, affecting one child in four. Every morning, dozens of women bring one or several children to MSF's feeding center, drawn by the promise of food and free medical care. When they arrive, the children's malnutrition level is determined using the MUAC (mid-upper arm circumference) test, which involves placing a paper bracelet around their upper arm and pulling it until it closes on the arm. There are three zones, seen through a small window, that gives a quick estimation of the level of malnutrition for the child. If the MUAC measures in the green area, the child's nutritional status is good. Yellow zone shows early signs of malnutrition. Red indicates severe malnutrition and calls for immediate medical care. One by one, the children are weighed and measured so that the medical staff can get a more precise picture of the severity of their malnutrition. Their temperature is taken and a doctor examines them carefully, administers antibiotics, vitamin A and folic acid to prevent anemia and vaccinates them against measles. The most severe cases — the children who, without adequate nutrition and medical care, could experience serious side effects or death — are referred to the therapeutic feeding center (TFC) in El Genina, five kilometers from the camp. Treatment without hospitalisation But the staff at MSF's outpatient feeding center tries to spot the severe cases of malnutrition early to avoid the need for hospitalization. "After the medical consultation, we give out a plumpy nut sachet, an enriched ready-to-eat food made from a peanut butter base," explains Florence, the MSF nurse who oversees the children's treatment in the center. "We watch to see if the child manages to eat, if he has an appetite. If he does, he can go back home with a food ration to share with his family. It includes five kilos of CSB (a vitamin-enriched corn soy blend) and a litre of oil. He doesn't have to come back until three days later, when he will be examined again and receive more food. But if he doesn't eat well, he must be referred to the hospital for proper treatment and nourishment." The advantage of the outpatient therapeutic feeding center is that mothers, who are often the head of family here, can return home and care for their other children. When a child is hospitalized, the other children are left on their own and mothers cannot look for the food, water and wood necessary for the family's survival.