In addition to treatment programs for children suffering from severe malnutrition in Maradi, Niger, Doctors Without Borders/Médecins Sans Frontières (MSF) took the decision to provide food aid to 25,000 children in the Maradi region suffering from moderate malnutrition in order to protect them from slipping into a severe state of 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," said Christian Revert, an MSF logistician. 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 aroused 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.

Only children below 110 centimeters (43 inches) are entitled to this targeted distribution. Photo © MSF

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 showed the dangers that crowds pose during food distributions. Ropes marked off the circuit leading to the aid and the children passed through, village by village. Village leaders were responsible for maintaining calm.

A Yellow Bracelet

The circuit began with a wooden frame. A bar was set at a height of three and a half feet and the children who could able beneath it were allowed to continue. The others stopped there. They were older than five and, thus, 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 youngest family member. Further on, a yardstick was used to identify children below 25 inches in height. Those children, malnourished or not, would receive a food distribution and, thus, a bracelet.

A yellow bracelet for those who "qualify." Photo © MSF

All children measuring between 25 and 43 inches continued on to the next step, which involved evaluating the degree of malnutrition by using a plastic bracelet to measure their mid upper-arm circumference (MUAC). The bracelet has four zones that correspond to green, yellow, orange, or red strips, depending on the circumference. A child whose measurement falls in the red zone was suffering from severe malnutrition, and would be admitted into the MSF treatment program and either hospitalized or monitored at home, depending on the state of his health. Children whose MUAC measured in the orange zone, indicating moderate malnutrition, would receive a yellow bracelet. Those with yellow or green MUAC measurements returned home after receiving zinc to prevent diarrhea.

As the children under five years old passed through, MSF teams also watched for sick youngsters, and sent them to the hospital or the health center. These facilities were supplied with medicines and MSF had entered into agreements allowing children under five to be treated there at no cost.

"I've never seen a day like this," said 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.

Total Number of Children Registered: 7,186

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 five 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 center for care.

Balancing A Sack on Their Head and Carrying Oil Containers in Their Hands

On Saturday, July 23, the day of the first food distribution, thousands of mothers showed up again to wait. Using a loudspeaker, Revert reminded them that only children wearing a yellow bracelet could enter and suggested that the other mothers go home. But sometimes it's too hard to give up and the crowd remained dense. Despite the frustration among people who received nothing, the distribution took place calmly and without incident.

People lining up to receive food aid. Photo © MSF

The mothers lined up so that the team could check the bracelets. They 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 each mother was given a 55-pound sack of Unimix, flour enriched with vitamins and minerals. With a four liter container of oil in one hand, a quart 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 over three months. This aid totals 1,875 tons of Unimix and 375,000 liters of oil. However these impressive quantities represent 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 agencies become involved.