In Niger, the number of children suffering from severe malnutrition in Doctors Without Borders/Médecins Sans Frontières (MSF) therapeutic feeding centers remains at its highest level. Thierry Allafort-Duverger, head of MSF's emergency desk, reflects on a nutritional crisis, which is far from over.

What is the latest on the nutritional crisis in Niger?

Since the start of 2005, 30,000 children suffering from severe malnutrition have been admitted to our therapeutic feeding centers. We expect to treat up to 50,000 by the end of this year. The admission rate in our therapeutic feeding centers in Maradi and Zinder remains at its highest level. In the region of Maradi, in the second week of September, we reached a peak of over 2,000 admissions of children suffering from severe malnutrition.

Since April 2005, MSF has called for the implementation of free food distribution. What is the current situation in terms of access to food for the people of Niger?

Up until July, we have continually questioned the decision taken by the Nigerien government and other aid providers to respond to the crisis by selling food rather than distributing it for free. From mid-July, the increased media coverage–which was late but nevertheless effective–has led to an international aid effort. However, the implementation of food distributions organized by the World Food Program (WFP) has been targeted according to harvest levels, without taking into account the nutritional status of the people concerned. Consequently, they have failed to reach those most in need.

As things stand, the Nigerien government, with the support of WFP, is calling for food distributions to end in the beginning of October–two weeks after the beginning of the harvest – so as not to destabilize the market. It is true that an injection of outside food aid could hamper the sale of harvests and could have a negative effect on the resources of Nigerien farmers. But as the UN Secretary-General remarked to the Financial Times after his visit to the country on August 23: "When it is too late for prevention, because a crisis has already erupted, life-saving emergency aid cannot be subordinated to some future goal of self-reliance." ¹

We're still faced with an emergency situation and therefore welcome any efforts to provide free aid to affected families in order to prevent their children from falling victim to malnutrition. That said, we insist that the distributions be redirected towards the areas in which families suffering from acute malnutrition are located.

MSF teams are going to distribute a proportion of the UNICEF aid to the most affected villages to the south of Zinder. This is welcome news.

Is the food shortage the sole cause of malnutrition?

Since the beginning of the year, MSF teams have noticed an abnormally high admission rate of children suffering from severe malnutrition, that is, children in danger of dying. This year's rate is triple that seen this time last year. It's when we started admitting these children that we discovered the extent of the food shortage in Niger.

The shortage is not linked to food production, but rather to distribution of the food. In fact, we've noticed that the majority of the children being admitted to our centers come from regions in the south, considered to be "the cereal belt" of Niger, and therefore less affected this year by the drop in harvests.

It's in fact the poorest families who have been affected. They have no means of paying for food and no means of paying for care when their children need it. They're not in a position to cope with the increase in prices brought on by market deregulation and speculation.

The reality is that the problem is not due to production as such, but also to the existence of poverty in certain sections of the population. Ignoring this reality is akin to condemning the most at-risk families.

What can be done with a situation that is often presented as inevitable?

Since 2001, we are working in Niger and have recorded widespread endemic acute malnutrition, with yearly epidemic peaks of varying intensity. The slightest breakdown, be it a drop in harvests or a rise in prices, is enough to trigger a dramatic rise in the number of children falling victim to severe malnutrition. However nothing has been put in place to combat this highly endemic situation or to provide an emergency response to epidemic peaks. As a result, thousands of children are sacrificed each year.

The current crisis has provided us with an opportunity to re-focus international aid agencies on the problem of malnutrition. The government, UNICEF, and other organizations that have intervened during the course of the nutritional crisis are working together to put in place a permanent system for the treatment of acute malnutrition. To date, MSF has treated up to 30,000 children and has shown that such a system is possible. But our action alone is not enough to tackle a problem that affects tens of thousands of children each year. And since the families concerned don't have the means to pay for medical care and specialized food for young children, these provisions must be made freely available in health centers within the Nigerien health system.

¹ "Africa cannot grow or be free on an empty stomach", opinion piece by Kofi Annan in the Financial Times, August 29th, 2005