In Niger, malnutrition is a chronic situation, not an exceptional emergency.
Over the past six months, in 13 of MSF's largest malnutrition programmes, MSF treated over 10,000 people, the large majority of whom (88%) were children under the age of five. The nutritional programmes considered are in Sudan, the Democratic Republic of the Congo (DRC), Liberia, Ivory Coast and Niger.
Dr Milton Tectonidis, the doctor in charge of malnutrition issues at MSF headquarters in Paris, France, has watched the developments in managing malnutrition and says that, far from being inevitabitale, malnutrition is often the result of political decisions.
Dr. Tectonidis, has surveyed the information gathered from January to June 2004 from the selected projects to try and draw some lessons indicated by the results gathered. This work has once again demonstrated the political nature of malnutrition, and evaluated the development of MSF's management of malnutrition.
"In all these cases, except for Niger, malnutrition is the result of a conflict involving massive population displacements," Dr. Tectonidis said.
Between January and June 2004, MSF received nearly 9,000 children under the age of five into our therapeutic management programs for severe malnutrition in the selected project sites.
Instability and malnutrition strongly correlated
The two most unstable situations, namely the Sudan and the DRC, are also where MSF's nutritional activities are the most concentrated.
"In northern Sudan, in Bentiu, the constant instability aggravates the food and sanitation situation. However, in our therapeutic nutritional centre (TNC) in Akuem, in the southern part of the country, we have seen a drop in admissions in 2004, since the past two years of stability have allowed for good harvests in 2003," explained Dr. Tectonidis. As for Darfur, the violence and mass exoduses have had serious consequences on the food supply. In certain refugee camps, the high malnutrition rate among children under five has reached 25%.
The fluctuation in admission rates in the TNCs according to combats or periods of stability is also blatant in the DRC.
"After the army retook the city of Mukubu, admissions dropped and we closed the TNC. However, in the city of Kayna, in North Kivu, currently one of the most instable regions in the country, the food situation is extremely serious ", said Dr. Tectonidis. MSF TNCs have, on average, five admissions a day, and what is being seen is considered alarming: "60% of patients suffer from kwashiorkor (malnutrition complicated by major deficiencies in vitamins and micronutrients) and many adults suffer from severe malnutrition", he said.
Structural malnutrition: Do not scarifice the present to ensure the future
There are countries where malnutrition is related to structural causes (natural factors, extreme poverty, carelessness on the part of the government, etc.). In Niger, the MSF's program in Maradi managed nearly 13,000 patients between August 2001 and August 2003. During the first six months of 2004, 3,245 children were admitted to the centre. The long-term solutions proposed to remedy the chronic lack of food often rests on major development projects.
"On the one hand, I fear that these projects are simply paying lip service; on the other hand, it is unacceptable to sacrifice the present to ensure the future. While we wait for development in the next 20 years, now is the time that malnourished children need our help", Dr. Tectonidis said.
"Lastly, to quote what Amartya Sen, Nobel Prize Winner in Economics, said, "There is no such thing as an apolitical food problem" (Poverty and Famines: An Essay on Entitlement and Deprivation, Amartya Sen, Oxford: Clarendon Press, 1981.)