“She was vomiting and had diarrhoea, and she kept losing weight. Her mother just didn’t have enough milk to feed her,” says Mariam* of her five-month old granddaughter Nazia. “We went to a private clinic but they couldn’t help us, and finally we drove here from our home district of Sangin. Nazia is feeling a little better now.”

Nazia, who still has a bloated stomach and a clearly visible ribcage, is one of the patients in the therapeutic feeding centre of Médecins Sans Frontières (MSF) in Boost hospital in Lashkar Gah, the capital of Afghanistan’s Helmand province.

Boost hospital, where MSF has been working since 2009, is one of only two hospitals in the whole of southern Afghanistan. Helmand is one of the country’s most war-ravaged provinces, and has seen intense fighting over the past decades. It is home to a largely poor, rural population, even if there are signs of a growing middle class in Lashkar Gah.

Poverty main reason for malnutrition

MSF opened its feeding centre in December 2011 to tackle the chronic problem of malnutrition among children in Helmand. This specialised unit helps children on the verge of starvation gain weight through assisted feeding.

“Some children weigh as little as two kilos when they first come in,” says Christwish Wenyika, nurse supervisor of the feeding centre and the paediatric ward at Boost hospital. “Malnutrition is one of the main causes of death among children under five years of age here in Helmand.”

Seven months after opening, the 22 beds of the feeding centre are full. About 15 new children arrive every week – some less than a month old.

Malnutrition is a big problem in southern Afghanistan, and one of the main reasons for this is poverty. Even when there is food for sale in the markets, large families, in particular, often cannot afford to buy what they need, so many mothers cannot produce enough milk to feed their babies.

“It is heartbreaking to see the condition some of the children are in because their mothers don’t have enough to eat,” says Christwish. “We start with assisted feeding immediately, as soon as they arrive. The different supplements provide vital nutrients that the children are missing.”

Lack of education

Another contributing factor is a lack of education. Many mothers have never been taught how best to position their babies while breastfeeding, which means that not enough milk is produced. It is a vicious circle, as the less a baby breastfeeds, the less milk is produced by the mother.

Cultural factors also play a part. “In some communities there is a belief that breastfeeding leads to ageing, for example,” says Assadulah Muhamad Amim, a nurse supervisor with MSF. “We are working very hard at not just treating the children, but also at teaching families and communities through health education.”

Most children stay between one and three weeks in the feeding centre, by which time they are well enough to be discharged.

“I’ll never forget one woman who came in with newborn triplets,” says Assadulah. “The mother came from Marjah, a district close to Lashkar Gah, and was very attentive to her children, but at the same time realised she couldn’t feed them all. She and the triplets ended up staying 20 days in the hospital, and it was incredible to see how healthy they were when they left. They still come back every two weeks for checkups.” 

* Names have been changed.