The first warning about Niger's nutritional situation was sounded in October 2004. However, by late June, the international aid system was still unable to deliver appropriate assistance to those at greatest risk. In simple terms, this means a death sentence for the children of Niger's poorest families. The following is an assessment of the slow response to the nutritional crisis in Niger by Dr. Isabelle Defourny of Médecins Sans Frontières (MSF).

October 2004: A team from the Food and Agriculture Organization, the World Food Program (WFP), and the Permanent Inter-State Committee for Drought Control in the Sahel observed a 223,448-ton cereal shortfall in Niger for the 2004-2005 year — 7.5 percent of the national need. While this was not a huge deficit on a national level, the international organizations warned that it should not mask the extreme food vulnerability facing more than 3 million people in 3,000 villages, and recommended that public authorities and development organizations intervene to make up the shortfall.

In late November, following this evaluation, the Niger government requested 78,000 tons of cereal from the WFP, but received only 6,652 tons, or less than 10 percent of its initial request.

During January, February, and March, the number of children suffering from extreme malnutrition at MSF feeding centers rose dramatically. In April, nutritional surveys confirmed the gravity of the situation. Niger's National Assembly issued an emergency call for food aid to the international community.

On May 19, the United Nations requested $16 million to contain the crisis. Several days later, Niger's prime minister, Hama Amadou, repeated his government's request for aid.

The most vulnerable must pay for food

Given all these warning signs, how did the situation become an emergency? In the face of the crisis, Niger's authorities, with the support of international agencies and development organizations, responded primarily by setting up a system to sell millet at "moderate cost".

From September 2004 to June 2005, 42,000 tons of millet was sold at below-market prices. However, those quantities could not meet the needs of the 3.4 million vulnerable persons, constituting, on average, barely more than 12 kilograms of millet per person for nine months. One person consumes 20 kilograms per month on average.

In early June, Prime Minister Amadou acknowledged that the government's response was ineffective when he noted that hundreds of thousands of the 3.5 million people threatened by the food shortage were too poor to be able to purchase cereal, even at a low price. Those most severely affected by the food crisis have the least resources, including farmers whose harvests were poor and cattle producers and craftsmen. Many had already exhausted their resources, selling goods and animals to feed themselves.

The government then offered another solution, proposing to offer cereal loans to be repaid after the harvest. While such action has the advantage of providing food immediately to those in the greatest need, it seriously strains families' reserves for the coming year and continues the vicious cycle of shortages.

In fact, these actions force those in the greatest need and with the fewest resources to pay for aid.

Poorest have no access to health care

The health-care situation facing severely malnourished children (those in imminent danger of death) can be taken in quickly: people in Niger must pay for health care, making it inaccessible to the poorest people. Today, MSF is the only humanitarian group to have set up a health-care program for those suffering from malnutrition.

Retrospective mortality surveys conducted by Epicentre and MSF in April in the Keita, Dakoro, and Mayayi regions show that mortality rates among children under 5 were already above emergency thresholds (considered 2 deaths per day per 10,000 people) at a time of the year when rates of illness are low. Diarrhea and malaria will appear when the rainy season arrives, further weakening children whose health is already stressed by the lack of food.

While MSF believes that free food distribution is the only way to keep the situation from worsening and to prevent large numbers of deaths, donor governments, UN agencies and the Niger Government are always highly reluctant to conduct them in the areas most affected by food shortages - and still do not plan to hold any.

The risk of destabilizing the market — the argument that donors, UN agencies, and government cite to back up their refusal — should not take precedence over providing life-saving aid that could keep the weakest from sinking into malnutrition and dying quickly. Despite the promise from Niger's health minister, there is still no free medical care for children under 5 in the most affected areas.

This refusal to acknowledge the urgency of the situation and consider taking exceptional measures will condemn the children of thousands of Niger's poorest families to die of hunger.

MSF nutritional programs in Niger

MSF has been working in Niger in the therapeutic feeding center of Maradi since 2001. This year, in response to the emergency, MSF has opened three new therapeutic feeding centers, one in Dakoro in the province of Maradi and two in Keita and Tahoua in the province of Tahoua.

In addition, 27 ambulatory therapeutic feeding centers carry out screening and weekly treatment of children whose condition does not require hospitalization. The children in our severe malnutrition program receive, on top of therapeutic food, a weekly family food ration. At the end of their treatment, MSF distributes a one month food ration to each family (cereals, beans and oil).