The majority come from the ambulatory therapeutic feeding centres scattered around the district of Tanout. MSF located them in such a way that no mother with a severely malnourished child has to walk more than 20 kilometres to reach the closest ambulatory therapeutic feeding centre.

Tanout - Inside the tent, two doctors move from one bed to the other, checking on children and talking to their mothers. At each bed, a worried yet hopeful mother stands close to her severely malnourished child. This is the intensive therapeutic feeding centre run by Médecins Sans Frontières (MSF) in Tanout, one of the districts where the nutritional crisis in Niger has hit hardest this summer.

Tanout is located just South of the Sahara desert, in Zinder district. It is one and half day drive from Niamey, Niger's capital city.

"Most of these children would die, if they were not treated", says Rosa Crestani, Emergency Coordinator for the MSF nutritional project in Tanout. "Instead, when they come with their mothers, we manage to save more than 90% of them. Since the beginning of our work in this area, in late August 2005, we've treated more than 2,200 children."

Although the crisis is over its peak, severely malnourished children, most of them under three years of age, continue to arrive at the centre, accompanied by their mothers.

"There are always between 20 and 40 severely malnourished children hospitalised," says Rosa.

The majority of them come from the ambulatory therapeutic feeding centres scattered around the district of Tanout. MSF located them in such a way that no mother with a severely malnourished child has to walk more than 20 kilometres to reach the closest ambulatory therapeutic feeding centre.

"We try to treat as many severely malnourished children as we can in our ambulatory centres", says Rosa. "It is much easier for the mothers, who usually have other children to look after."

In the ambulatory feeding centres, the severely malnourished children come once a week with their mothers. After having been weighted, they are checked by a nurse; they receive therapeutic food for a week (plumpy-nut, a cream that can be directly consumed by the child and does not need cooking nor water; the necessary medicines (most of the time against diarrhoea or malaria); food for their family, mosquito nets, blankets and soap. They return every week, until they are completely recovered.

But some children coming to the ambulatory feeding centre arrive so severely malnourished that they require immediate hospitalisation. Thanks to the ambulance service set up by MSF, they are able to reach the intensive therapeutic feeding centre in Tanout.

"When they are admitted to the therapeutic feeding centre, they are often in a life-threatening condition", continues Rosa. "Thus, they are hospitalised, together with their mothers and put under 24 hours medical surveillance. They receive the necessary medical care and therapeutic food, when they are weakest, and then plumpy-nut".

After two weeks children are usually well enough to go back to their villages. There, their mothers will bring them to the nearest ambulatory feeding centre once a week, until they are completely recovered.

Outside the tent, Rosa shows a group of smiling mothers with their children. These kids look much healthier than those inside the tent and yet they were exactly in the same conditions just a couple of weeks ago. "Look at these mothers, how they are smiling", says Rosa. "Their children have survived, and they know they are going back home very soon".

Since the beginning of the year, MSF has treated more than 60,000 severely malnourished children in Niger.