Following the 2005 crisis, many aid providers made commitments to prevent a similar scenario. But in the field, MSF's team is concerned about the lack of follow-through on these commitments. Emmanuel Drouhin, head of MSF's programs in Maradi, Niger, describes the current situation.

What is the situation at the beginning of April?

"We are currently treating nearly 3,400 children suffering from acute malnutrition. The number of new cases admitted each week doubled between mid-February (around 500) and mid-March (around 1,000). This is already relatively high. Yet since 2001, we have witnessed a very sharp increase in the admission rate that occurs from June to October during the months preceding the harvests, the in-between harvests—the period when families' food supplies dwindle.

"Today's information, recent history, and logistical constraints (buying, transportation, etc.) related to food aid mean that we must make decisions now in order to respond in a timely fashion. Of course, no one can predict the future, but the onus is on all aid providers to be prepared."

Do we have the resources to deal with a worsening situation?

"In addition to the two therapeutic inpatient feeding centers in Maradi and in Tiberi, each with 300-bed capacity, MSF has some 10 outpatient feeding centers in two departments — Madarounfa and Guidan Roumdji, in the Maradi region. These outpatient centers allow us to provide medical care to more children since they follow the treatment at home as outpatients and only come to us once a week for a check up. Only those children suffering from medical complications or who have lost their appetite need to be hospitalized.

"The other advantage of this strategy is the ability to quickly adapt our capacities according to the situation, by opening or closing outpatient centers. This responsiveness produces better results.

"By refocusing our activities during the course of the year on the most vulnerable departments, we treated 39,000 children in the Maradi region in 2005 (more than 63,000 throughout Niger) with a cure rate of more than 90 percent. But last year, we made the mistake of not giving ourselves enough lead time for our food orders to be delivered. The delivery takes up to two months. This meant that we had to order emergency supplies which is much more expensive.

"This year, we have already placed additional orders (enriched flour, oil) so that the supplies will be on location by early June. We then will be able to respond fairly quickly in those places where we operate, but that only covers a small portion of the actual population at risk."

What has changed since 2005, the year when the extent of acute malnutrition in Niger was fully realised?

"The key players (the Niger authorities, international aid donors, UN agencies, NGOs) decided to take on the problem of acute malnutrition. A new protocol was implemented and a fairly ambitious action plan for 2006 was mapped out. One of the objectives is to treat some 500,000 children suffering from acute malnutrition and to have targeted food distributions.

"In theory, these plans should be a marked improvement over previous years. But in the field, not much has changed: insufficient funds, supply problems with food or therapeutic products, lack of organizations on the ground to ensure distribution, etc. Many reasons are given to explain the actual problems related to aid distribution.

"By early April, there is no longer sufficient time for projects or explanations. The question is whether the other providers are mobilizing their resources to take on malnutrition as they pledged to do so. We are waiting for the answer in the field. "