In Chad, a donkey trek can save a life
Dibinindji - Mothers with hungry and malnourished children are travelling by any means they can to get to feeding sites and clinics in the Chadian desert, such as Dibinindji, where no roads exist and where it is sometimes too late to save their babies' lives.
Twenty-two children have died this year from malnutrition in another district in Chad's Sahel belt. Health and UN officials warn that more children will die if the international humanitarian assistance is not increased.
The inhabitants in this vast expanse of the Chadian desert eke an existence from subsistence farming in this unforgiving environment, and this year it has been especially unkind.
Outside the clinic, a mother arrives from the desert by donkey, leaves the animal with a dozen others under the shade of a tree that serves as a donkey parking lot, and walks toward the clinic, shielding the child under her yellow shawl from the harsh noontime sun.
"Halime Ali?", a nurse shouts out. A mother brings baby Halime to be weighed. She cries as she is lifted into the plastic weighing bucket, and again as she is lifted out by one arm.
Dr Beban Behoutam Sylvestre, the chief doctor of the district of Mondo, said the centre has registered 22 deaths since the beginning of the year. Admissions in the early months of this year tripled over admissions during the last half of 2011, he said.
"The children are brought to the centre very late. Once they arrive to the centre, it's already too late to treat them," he said. "Another reason that presents itself is the transportation conditions. When a child is sick they bring them on the back of a donkey or camel, or even a cart," and those modes of transportation are not ideal for children with severe acute malnutrition.
Unicef estimates that 127 000 children under the age of five in Chad will suffer from severe acute malnutrition this year. The hunger crisis extends across many countries including Niger, Mali, Mauritania and Burkina Faso, and the UN estimates 1 million children this year will require lifesaving treatment for severe acute malnutrition in the wider Sahel region.
"These numbers are quite staggering in my opinion. We really need to do something urgently because if we don't act now then we may take the chance of losing so many children who will die of malnutrition," said Unicef's deputy representative to Chad, Dr Marcel Ouattara. He blamed climate change for Chad's hunger crisis.
Rehab centres to double
The region has not yet recovered from the last drought two years ago, and many families lost their herds which means that they will not have assets to purchase food.
In an April press release, Unicef said it had set up 261 nutrition rehabilitation centres in Chad, and has plans to double the number in the next two months.
The medical facilities in the region, however, are ill-equipped to resuscitate patients in the worst conditions, Dr Sylvestre said. An oxygen concentrator with a generator or solar panel is greatly needed because patients are dying from respiratory distress, he said.
A lack of medical personnel is also a factor. In March the centre saw 55 cases but had only four nurses who had to work long hours.
"So at this level we have many different difficulties that contribute to the deaths of these children. If only we had an ambulance," he said.
Ouattara said that more international funding is needed to help fight the hunger crisis. He said right now he has less than 50% of the funds he needs to treat the crisis in Chad.
"For the time we're trying to be hopeful because we don't have any other choice but to be hopeful. It is heartbreaking to see that the need is there," he said.
The upheaval in neighbouring Libya has also contributed to the crisis. Chadian citizens who used to work in Libya and send money back home have instead returned to Chad. That means less money for families and one more mouth to feed, said Ouattara.
ICU in a tent
The more severe cases of malnutrition are referred to an intensive care tent in the grounds of a hospital in the nearby town of N'Gouri, itself hours across the desert from any road.
Inside, mothers attempt to feed their children but many are beyond the point of accepting food orally and lie still in stifling summer heat as their mothers fan them.
Their tiny hands are bandaged up to prevent them from removing the nasal feeding tubes that sustain them. Within a couple of weeks most will recover.
One mother pushed a cup of fortified milk up to the lips of her 8-month-old daughter Kouboura Ali, who arrived at the clinic two days before weighing only 2.8kg. The frail girl swallows some but seconds later vomits it back up.
Fatime persisted but it was of no use. A doctor arrived and gave Kouboura an injection of antibiotics to fight infection.
"During the three days I've been here my child has received treatment," she said through translators. "I'm happy with how it's going."