October 21, 2008
MSF Calls on President of Niger to Lift Ban on Organization’s Nutritional Programs Immediately

Niger 2008 © MSF

Nicolas de Torrenté, executive director of MSF-USA and Marie Pierre Allié, president of the French section of MSF, discussed the organization’s suspension from treating malnutrition in the Maradi region of Niger.

The suspension endangers the lives of thousands of children vulnerable to malnutrition in Niger. For the sake of these children, MSF has called for an immediate resumption of its nutritional programs.

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Transcript

Sandra Murillo:
Good morning, everyone. And thank you for joining us today. As you know we will be discussing the suspension of Doctors Without Borders/Médecins Sans Frontières malnutrition treatment programs in the Maradi region of Niger. On the call this morning are Doctors Without Borders/Médecins Sans Frontières USA Executive Director, Nicolas de Torrente, and Dr. Marie-Pierre Allié, President of the French section of Doctors Without Borders/Médecins Sans Frontières. Dr. Allié is speaking from Niamey, the capital of Niger, where she recently returned from meetings with health care staff and hospitals and health centers who are unable to cope with growing needs of malnourished children in this region of Niger. At this point, I'd like to hand the conversation over to Nicolas deTorrente and after the two brief presentations we will open this call up to your questions. Thank you.

Nicolas de Torrenté:
Good morning, everybody. Thank you for being with us today. Thank you for your interest in this situation. As you know, malnutrition is a medical emergency accounting for about 11 percent of the global burden of disease. It contributes to between 3.5 to 5 million deaths estimated in children under five every year. The WHO, the World Health Organization, estimates that there are 178 million children who are malnourished across the globe and at any given moment, about 20 million of those are suffering from the most severe form of malnutrition, the most life threatening one.

According to our estimates, only 3 percent of the 20 million children suffering from severe acute malnutrition receive the UN recommended treatment that they need. Now Niger is one of the malnutrition hotspots around the world where areas that concentrate the highest burden of malnutrition. And Doctors Without Borders or MSF, our medical teams have been treating malnutrition in that country since 2001. They carry out programs in various parts of the country, in the Zinder, Maradi, and Tahoua regions. So these are the areas of the country with the highest incidence of childhood malnutrition in Niger. Between early 2008 and mid September, our teams had admitted a total of 61,051 children, so that's 61,051 children in feeding programs in Niger, children suffering from acute malnutrition.

This is a recurrent situation. Year after year we've treated tens of thousands of acutely malnourished children with therapeutic, ready-to-use foods. These are pastes, innovative pastes that do not require refrigeration or cooking. We're in a chronic emergency in which children, young children in these regions of Niger, are not getting access to food with vitamins, minerals and proteins, and other nutrients that they need to grow and survive. They require complementary feeding, they require therapeutic feeding when they are acutely malnourished.

It’s in Niger where a lot of progress has been made. With the support of the government, MSF has been able to pioneer a new approach to treat malnutrition. We are doing it on an outpatient basis using these ready-to-use foods. This strategy has helped us reach many more children than ever before. And starting in 2006, we've also been able to try new strategies that try to prevent children from developing this life threatening condition, the most severe forms of malnutrition, in the first place.

Our blanket distribution of ready-to-use foods to all children from six months to three years of age in the Maradi region dramatically reduced the seasonal peak in severe malnutrition just before the harvest. So this is this preventative, early treatment approach. It's an approach that we know is reducing child mortality and morbidity. This approach also costs less in terms of hospitalizing children who have fallen into the most severe forms of malnutrition. We recognize the need to find a long term solution to this problem of malnutrition rather than conducting emergency responses every year to the seasonal outbreaks of acute malnutrition that occur, particularly between the harvests. And we recognize the need to partner with the Government of Niger and the Minister of Health that have the long term responsibility for the care and welfare and health of the children in Niger.

And that's why it's so incredibly frustrating for us to be forced to cease this important lifesaving work and we are calling upon the government in Niger to let us immediately resume our nutritional programs in Maradi. At this point, the lives of tens of thousands of children are at stake. This whole crisis in Niger is revealing how difficult it is for governments to acknowledge malnutrition as a public health problem and hence as a public health priority that needs to be tackled by effective and efficient policies supported by international donors.

And at a time when government's own agencies, donors, and international aid organizations should be expanding such effective strategies for the treatment and increasingly for the prevention of malnutrition in the world’s most affected regions, the Sahel, the Horn of Africa, Southeast Asia, the current stance of the government of Niger is really a setback.

So I'm going to turn it over to Dr. Marie-Pierre Allié. She is the president of the French section of Doctors Without Borders responsible for the programs in the Maradi region of Niger. And she will speak about the needs we continue to see on the ground and also our desire to continue working in the country to help the government of Niger, the children of Niger, and the people of Niger address childhood malnutrition. So I'll turn it over to you, Marie-Pierre.

Marie-Pierre Allié:
Thank you, Nicolas. Hello, good morning to everyone. As Nicolas just told you now, childhood malnutrition is a regular challenge in Niger requiring long term and sustained action to combat. And we have been, together with the government in Niger, trying to address this issue for a number of years now. But right now we are facing a life-threatening emergency for thousands of children in the country’s Maradi region. On July 22, the government of Niger suspended our malnutrition treatment program in the Maradi region. At the time of the suspension, our nutrition program was admitting an average of 500 new patients every week. We are estimating, that there are as many as 8,000 children with severe malnutrition who have not been treated since this time because we were not able to protect them. Of course their fates remain unknown now.

So I came to Niger to try to come to a solution and to resume—for as long as possible—the program, for the sake of the children in Maradi. And I've been visiting the Maradi region where I saw-- I visited health structures, I met with staff, I met with mothers. I was really impressed by the situation and by [speaking with] health care staff especially because they basically are unable to cope with the influx of malnutrition [cases] coming into hospitals and health centers. And this is in sharp contrast with the declaration, with the statements, made by government officials a few days ago denying any problem in the area and denying the existence of the malnutrition in this area.

So to be more precise about what I saw, I visited the regional hospital in Maradi. I visited some health centers, I visited some villages where I [spoke with] with mothers. The number of children I saw myself in the health structures is much different from what I have been hearing from official statements. In the hospital of Maradi at the time I visited there were at least 150 kids waiting for care and the staff was trying to help. It's just there is not enough [health staff] to cycle the number of children coming to them. The centers were really overcrowded. Then in the village where we’ve been meeting with mothers, they all report the usual number of children dead in the past few weeks.

So the situation I've been seeing there, it's quite critical. And it's a bit upsetting to see the situation, to see the health centers overwhelmed, to see the staff in need of help and at the same time we are seeing the MSF structures empty and their adequate staff not able to give a hand. We know from the experience of our medical teams this year in the region that childhood malnutrition remains hidden unless effective treatment is made easily accessible. Since working there since 2001, we have seen tens of thousands of mothers bringing their malnourished children to our therapeutic feeding centers. Working in collaboration with the Minister of Health in the past, we have been able to implement effective, life saving treatments to help these children in the area. So today as a medical humanitarian organization we are urging the government of Niger to let us continue to practice this medicine. From what I'm seeing today, I can say these children cannot afford to wait any longer for the suspension to be lifted. Thank you.

Sandra Murillo:
Thank you, Marie-Pierre. We can answer any questions that you might have about the situation or if Nicolas wants to add some points at this time.

Nicolas deTorrente
I think we can open it up to questions, either to Marie-Pierre or myself.

Question:
Can you give me a little background on why the government of Niger would suspend your efforts?

Marie-Pierre Allié:
It is quite unclear why this very drastic decision was taken in the middle of July. There have been a variety of reasons that have been given, but the most frequent and the most worrying for us is that MSF is creating malnutrition, that if MSF is not present, there is no malnutrition in the area. And it is something that we can't accept. We know that when treatment is provided, mothers come. That's why we are treating malnourished kids. Of course if there is no effective treatment, mothers may stop coming and then of course we will not see them. But that [does not mean] that MSF is creating the problem of malnutrition. It's something that we cannot accept. This is the main argument and it's a situation where there’s a tendency to diminish the visibility of the problem of malnutrition.

Question:
And why would they want to diminish the visibility of the problem of malnutrition?

Marie-Pierre Allié:
When you speak about malnutrition, you speak about lack of food, money, etc. And that is something that is not really acceptable. But I think the main reason is that it’s difficult for the government to tackle these issues. They need means, they need money. And today because malnutrition is not recognized as a public health problem internationally, it's also difficult for them to get access to sufficient funds to finance these kinds of solutions. And this is an issue that we're talking about in Niger today. The fight against malnutrition needs to be considered a priority on an international [level] and donors need to invest more in this area. Then I think the governments of different countries would be able to tackle this problem.

Question:
I may be misinterpreting this, but are you saying that the government said malnutrition did not exist in the Maradi region before MSF got there?

Marie-Pierre Allié:
What the government has been saying to us in public declaration and also when we met them was that the problem of malnutrition exists, yes, but with not such big numbers than the ones we are treating now. And even in their latest declaration, by the Minister of Health, the Minister was saying that in the hospital of Maradi there were 46 kids hospitalized for malnutrition when that’s not what I saw when I was there. So this [shows that] there is no recognition of the problem. The government is just saying that malnutrition in the area of Maradi is not so important and the success is declining.

Question:
So just to confirm, the government is saying malnutrition did exist there, but basically your figures are exaggerating the problem?

Marie-Pierre Allié:
Yes, that's what the government is saying. But as we said, this is a question of offering care. If you offer an effective treatment, they keep coming and then we treat them.

Question:
Are there other NGOs that are working in Niger that have had this problem? Or WFP, are they doing emergency feeding now and have they run up against opposition from the government?

Marie-Pierre Allié:
Yes, as we speak there is another NGO facing the same kind of problem, suspension from activity. It's Action Contre La Faim (ACF) and their activities have been stopped since the beginning of August. So they are in the same situation as MSF. You can make a link to what is happening to us because it’s another organization working on malnutrition. And if two organizations treating malnutrition are not working there anymore, of course the number of children treated is going to diminish.

Question:
And is this the same government in power that was there in 2005 and that was concerned about when you were calling for international assistance then?

Marie-Pierre Allié:
Yes, President Mamadou Tandja was the president at the time. I think that what has been happening since 2005, putting Niger on the spot, speaking about the malnutrition crisis, the food crisis, etc., is something now affecting the government and the President in particular. But also during this time, Niger has been really, really taking new steps to fight malnutrition. After 2005, the National protocol has been modified, ambulatory care has been established, production of ready to use food has been established in Niamey. So there have been really, really good things done by the government, by the Minister of Health, in Niger to tackle malnutrition. So as a consequence of the 2005 crisis, I think there have been huge steps that have been taken by the government in Niger. That's why today what's happening to us is really quite a drawback from what has happened in past several years. And I really hope that we can [be reinstated] in order to get back on this positive track.

Question:
Rising food prices of the last year all over the globe, how much did they make the situation, the malnutrition situation in Niger worse? Did it throw a lot more people into hunger?

Marie-Pierre Allié:
No, I won't say that. To us what's important in this kind of situation is really to address the needs of the patients who are the most vulnerable. In this kind of situation, when there are food shortage everywhere, it’s the small kids who are the most vulnerable and we try to address these cases. So that's what we have been doing in the past several years, this year and the year before, is offering a supplementary food with minerals, nutrients, to these kids. And as we have been following it, it has been quite effective in terms of malnutrition affecting these young children. So before our suspension we didn't see the rise in food prices have an impact in the area.

Question:
Isn't it possible -- or is it possible that the government of Niger could take on this work itself? Reading the AFP article from yesterday, they said, the government can do it, we don't need Doctors Without Borders to take on the malnutrition problem.

Marie-Pierre Allié:
Yes, it's a real issue. I think what Doctors Without Borders/Medecins Sans Frontieres want to do, is really not to stay indefinitely in the region. And this is the kind of discussion that we were having with the Minister of Health. What we are expecting is to work hand in hand with the Minister of Health and staff in the health care system in order to implement new strategies making treatment simpler and more possible to run. But this is something that we need to build in the coming years and it's something for which we need more support, more finance than what exists today. I'm saying that without appropriate funding from international donors, it's going to be very difficult for countries like Niger to tackle the issue. But what we are speaking about today and what the Minister of Health is saying is that today the infrastructure [can handle the extent of the malnutrition problem in Niger].

What I've been seeing on the ground is that the health structures in Maradi are crying for help, the staff says, “we cannot manage with the number of people who are coming today for treatment.” The mothers are [used to knowing that when] their kids are malnourished, their kids can be treated, so they come to the health structures. Not all of them, but a lot of them continue to come. And it's creating a lot of pressure on health centers because today they don't have the means. You need some human resources, you need some ready-to-use foods, you need treatment. And today the health centers are not ready to handle such a big influx. But really, my discussion with the Minister of Health was to say, ‘Okay, let's try to work together to establish the possibility that in two or three years time MSF can withdraw and the existing health centers can take over.

Question:
Do you foresee a problem on the same scale as what happened in 2005?

Marie-Pierre Allié:
No, the situation we are describing today is not the one of 2005. The situation we are seeing today is created by the fact that the care that we [normally provide for the] children is absent. And that's also what's making the situation so sad. We have the means. We have our staff, who are quite well trained, able to treat malnutrition; our national staff is really very well trained. We have the staff, we have the structures, we have the equipment, we have the food, and we really want to treat the children. And this has been impossible for the past 13 weeks now and this is what is making the situation critical now. It’s mainly because there has been no treatment for the past month. [Now] children are not treated so they are still sick. We used to do prevention by distributing supplementary food to all kids from six months to three years and this [approach] was really showing good results in reducing malnutrition. Another worrying factor this year, the number of malaria cases is quite high, it's higher than it was last year. And of course when children get malaria, there is increased risk for them to become malnourished. So all of that makes the situation today more critical. But no, I'm not comparing today’s situation with what happened in 2005. I'm just saying that today in Maradi they have been waiting too long and really it is going to be quite important to intervene now.

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