They are sitting side by side on one of the blue mattresses in the MSF stabilization centre in Kuyera in the Oromiya region. Sheleme and Kutuba are twin sisters. Their tiny, four year old frames are dressed in identical flower print dresses. The twins were admitted to the centre today because they are both suffering from severe malnutrition and urgently need to be hospitalized. Karen, the MSF doctor, examines the little girls and something jumps out at her right away: Sheleme, who is staring up at her with mournful eyes, is suffering from oedema. As a result, her legs, feet and face are bloated and swollen. She has reached the kwashiorkor stage, which is evident by the swelling under her skin and indicates a severe stage of malnutrition. Kutuba is not suffering from these complications and she seems to be in a less serious state. All the same she also has a sad, lost, look on her face that is typical of severely malnourished children. Their mother Subo explained that this year, life has simply become too difficult. "The rains have stopped and the corn and beans didn't grow well. The cows didn't give any milk." It has become impossible for her and her husband, a famer, to feed their four girls and one boy. It is a few minutes after 4pm. At 6pm it will be time for the girls to take their first ration of F75. It consists of the lightest therapeutic milk that is given to children in "phase 1" of treatment. Sheleme will have to find her appetite now. She will have to rid herself of the oedemas that are disfiguring her face and causing her pain. The process will have to be taken little by little, step by step.