In Niger, bad harvests, exhausted food reserves, but more than anything else an incredible rise in the price of millet, have brought about a serious nutritional crisis. In the Maradi nutritional centre, MSF deals with severely malnourished children. Some, just two years old, scarcely weigh three kilos - less than the weight of a child at birth in Europe.
Mothers of children now hospitalized in the MSF nutritional centre in Maradi tell the same story over and over again, the story of how this past year has been far more difficult than previous ones. Harvests were not good and many families went through their food reserves very early in the year.
At the same time, the price of millet skyrocketed. "Today, a bag of 100 kilos costs more than 22,000 francs CFA (about 33.50 euros), instead of the usual price of 8,000 to 12,000 francs CFA (12 to 18 euros)," said Rakia Karimoune, a 22-year-old mother whose little boy, Rashid Ousmane, is hospitalised in the MSF centre. The market stalls are full, but at these prices, many families do not have the means to buy enough.
In theory, the system of sales at reduced prices now in place in Niger should make it possible to get millet for 10,000 francs CFA (approximately 15 euros). But, speaking with mothers under the ventilated tent that protects children from the sun during the day at the feeding centre, none of them here had benefited from this system.
"Perhaps there will be sales at reduced price later in the rainy season," wondered Zouley Hassa, here with her 9-month-old daughter, Zaharia Moussa.
That likely would not change the situation anyway, because 10,000 francs CFA is a large sum for these farming families who now have nothing.
"In my village, the old people beg and the 'valid arms'- as we call the men able to work - leave for town to seek work," said Zouley Hassa. When they manage to gather a little bit of money, families buy small portions of millet that cost 500 to 750 francs CFA (between 75 cents and an euro) - enough to survive for a few more days.
When these rations ran out, families are reduced to boiling leaves into a stew. This mixture - particularly when prepared with unsafe water - can cause diarrhea in children, who then risk losing more weight and becoming severely malnourished.
The local diet - based on balls made of millet paste - is neither rich nor varied enough, is deficient in vitamins and so weakens people, brings disease and accelerates the loss of weight. Such is the chain of consequences that brings many children to a state of severe malnutrition.
"Among the children who are admitted in the nutritional centre, it's often hard to tell if they fell sick because they were malnourished and weak or if the malnutrition is the consequence of their sickness," said Vanessa, chief doctor at the Maradi intensive care unit.
However one thing is clear: when they do fall sick, the majority do not have access to adequate care as they must pay for care in Niger and few steer clear of malnutrition. Rashid, 15-month-old, weighed just 5.8 kilos and was 66 centimetres tall when he arrived in Maradi. Zaharia suffers from kwashiorkor, a form of severe malnutrition that causes swelling of the children's abdomen.
Both are now hospitalized as in "Phase I", the emergency phase, where they receive eight rations of therapeutic milk every day; a systematic antibiotic treatment to fight possible infections; and an additional supply of vitamins.
The more serious cases, such as children with both malnutrition and disease are placed in intensive care.
A month ago, the number of children in critical condition was steadily increasing. As a result, MSF set up an additional tent to increase the number of beds from 36 to 54 in the intensive care unit. Both tents are already full.
Inside, patients include two-year-old children who scarcely weigh three kilos - less than the weight of a child at birth in Europe.