The outbreak claimed thousands of children's lives, with mortality rates reaching six deaths/per 10,000 children/per day - three times the emergency threshold at its peak in the spring. One mother from Kurmiyal estimated that the disease killed at least 50 children in her village alone.

On the surface, it was hard to see a nutritional crisis in and around the sprawling, dusty city of Katsina, just 75 kilometers south of Maradi, Niger. Home to more than 250,000 people, the city teems with motion from before daybreak to after dark. Motorcycles outnumber cars by three to one, and cars choke the streets with traffic. The market stalls are full, and trading is brisk. In the agro-pastoral villages throughout the countryside, cattle and goats abound, and by late-August, the millet and sorghum was shoulder high.

"I can't believe we have so many malnourished kids around us," said one local resident.

The children came from all over the state, some weighing as little as four pounds, all requiring emergency care. At the peak of the crisis in August, Massauda Isau faced an uphill battle just to reach her second birthday. Born in the remote village of Kadanya, 100 kilometers northeast of Katsina, the one-and-a-half year old had just overcome a two-week bout of diarrhea only to be left skeletal and wasted by both severe acute malnutrition and malaria.

"This is the first time I have had a child with this problem," said her mother, Umama, rocking the lifeless child in her lap.

"Everywhere we opened, we found more children," said MSF nurse Virginie Cauderlier. On the first day of a new outpatient program in mid-August in the isolated village of Randa, near the Niger border, MSF admitted nearly 50 severely malnourished children.

One of the reasons for the crisis was a measles epidemic, known as burkana in the local Hausa language, which swept through northern Nigeria in early 2005.

"So many children had measles," said a Nigerian physician who headed the stabilization center's intensive care ward. He flipped through a handful of charts, reading "measles" off every other one.

The outbreak claimed thousands of children's lives, with mortality rates reaching six deaths/per 10,000 children/per day - three times the emergency threshold at its peak in the spring. One mother from Kurmiyal estimated that the disease killed at least 50 children in her village alone.

As is common after such an epidemic, the children who survived became much more susceptible to other diseases, as well as severe acute malnutrition. Many of the children MSF treated, though, were spared the ravages of measles. Instead, they seem to have been caught in a spiral of disease and chronic food insecurity exacerbated by recent economic factors similar to, but nowhere near as pronounced or widespread as, those affecting people in Niger.

Throughout the region, the period from June through August is traditionally known as the "hunger gap". These months just before the next harvest are when food reserves from the previous year are increasingly depleted. In 2005, some of the poorest families were running out of personal food stocks months earlier.

To make ends meet during this gap, many people cope by buying food with whatever little income they manage to earn throughout the course of the year. The most destitute families, though, struggle to survive every year on next to nothing. In 2005, these families had to make do on even less because, the price for millet, sorghum and maize had more than doubled to the point where even gasoline was cheaper than all three staples of the local diet.

"It's hard to get three meals a day," said one mother of six from Batsari in late-August, echoing a sentiment expressed by others in Jibia, Mashi, and Katsina itself. "But we have no money, so now we just have one, sometimes two."

The little food available to these families also lacked variety, leaving many infants and small children without necessary micronutrients, vitamins, and minerals. This in turn led to a weakening of the immune system, making children much more vulnerable to diseases like diarrhea and respiratory infections. And even though a visit to the health center is free, if a child falls ill, the cost of medicines is far beyond many of these parents' reach.

"There are children dying here everyday," said MSF's medical coordinator, Dr. Andrea Minetti in late-August as he made rounds in the intensive care unit of the stabilization center. He checked the pulse of a critically ill child.

"He has cardiac failure, secondary to severe malaria and anemia. And outside it's like a normal city. But this," he said while gently touching the child's feverish forehead, "this is not normal."