Biting hunger leaves a trail of death and despair in its wake

Mrs Fatuma Nur
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Photo credit: Angela Oketch | Nation Media Group

The air in the paediatric unit of the Wajir Referral Hospital is stifling. As we entered its narrow blue coloured hallway, a sickeningly pungent smell embraced us. We held our breaths in anticipation of the despair we were about to witness.

A brief meeting with Dr Zahara Haji, the unit’s senior medical officer, set the stage for heartbreak:  “We have just lost a child this morning, she was severely malnourished and was brought to the hospital very late.”  That was her welcoming message.

The hospital’s paediatric unit has been overwhelmed by an avalanche of malnutrition cases needing immediate hospitalisation and stabilisation. For the last three months, the hospital has been admitting an average of 20 new patients per week for severe malnutrition. The whole ward is normally full with malnourished patients, luckily, on this day, only Abdakir Ibrahim was left, many had been discharged, some had died and more were being admitted.

Too frail to cry and too weak to play, Ibrahim lay in his grandmother’s arms and stared at us motionless, fraught with hunger, strained by the heat and weighed down by the catheters attached to his tiny hands. He struggled to sip milk from the small green cup held by his grandmother.

Ibrahim was admitted early this month when all his organs were almost shutting down. At one-and-a- half years, he weighs 7.4kg, way below the expected 11kg. He had stopped feeding and was suffering from diarrhoea, which points to a lack of clean water.

Loss of weight

Walking five kilometres to the hospital, all the family could ask for from God was to spare their only son in a family of five girls.

“I thought we were going to lose him and my prayer was just to arrive at the hospital alive... We were starving and all we could eat was black tea, every day,” said Salman Ahmed, the 70-year-old grandmother.

“When a child doesn’t eat enough, it leaves her or him more susceptible to infection and illness,” Dr Haji said. “And the more a child is ill, the more she loses weight and becomes malnourished. It creates a vicious cycle.”

Since Ibrahim’s body did not have the same ability to fight off infections, he was always sick. The fact that he had little appetite only aggravated his condition.

“With the kind of situation we are in now, mothers are giving anything available to the children just to calm the hunger... including boiling sweet potato leaves and even eating feeds meant for domestic animals,” said Dr Haji.

She explained that when the child is brought to the hospital, the first thing they do is to ensure that they are taken through nutritional therapy and then tests are done to identify what the patient needs most. The patient is then fed F75, a ready-to-eat therapeutic food to help stabilise his organs before graduating to F100.

Dr Haji said that children with malnutrition are categorised as at risk, moderate and severe, and each category is handled differently.

“When a baby is severely malnourished, you cannot put them on high-calorie foods until they are stable. That is why they are treated with F75 first,” she explained. “When they feed, they stabilise, the challenge comes when the child is not eating and does not have the appetite.”

Ibrahim is a representation of many children who are now suffering given the situation in the country; Kenya is currently facing the most severe drought in 30 years.

Failed rains have led to failed crops, severely hindering the ability of many parents to provide for their children. The children, more so, in Wajir are not eating nutritious foods.

The under-five are the most affected because their immunity is compromised. For this group, nutrition is vital, however, many families now survive on a diet of boiled water with sweet potato leaves and wild fruits.

Wild animals

Fatuman Nur walks for seven hours looking for life-giving water. She begins her journey as early as 4am in the morning, ready to face the wild animals, rapists and other dangers in search of the precious commodity.

With the help of her mother, they tie her one-year-old twins Abdullahi Ahmed and Salman Ahmed to their backs and begin the journey. At exactly 10 am, they arrive at the water point. The line is long and the earliest she will fetch water is 12pm. She has to wait.

For many of us, water is just a tap away but for Nur getting access to this life’s most basic need is not a struggle. As she waits her turn, Nur calms the restless twins, they are hungry; the last meal they had was sugarless strong tea and a piece of ugali. She was equally weak.

“My legs are sore, my back hurts, and I’m in pain. But I have to get water for my family and animals,” says the mother of four.

On this particular day, a convoy of vehicles from Save the Children arrived at Tarbaj sub-location to conduct a monthly outreach on malnutrition. She thought that they had brought food aid, but it was only medicine and some food supplement. The area is known for high numbers of malnourished children.

Several mothers stand closely in a group with their children at their sides. The mothers gathered at this Save the Children-supported Integrated Management of Childhood Illness (IMC) clinic because many of their children suffer malnutrition. Each child seemed to be at a different stage of malnourishment. Their bloated bellies and unnaturally thin arms stood out.

It was her turn to be served and looking at the twins, you would be forgiven to think they are well fed. The white patches on their skin, however, tell a different story. One of severe malnutrition. After being attended to, she sat in a shade and opened a soiled white jerrican. In it was strong tea that the twins drunk without a pause.

Their condition, according to James Eipa, a paediatric nutritionist, is a result of poor feeding. The twins get too many carbohydrates and too little protein in their diet. They are mostly fed ugali and black tea and at times porridge.

Government supplied complementary foods are hard to come by for the families in Wajir, which is one of the 23 arid and semi-arid counties ranked as the most food insecure.

The gravity of the situation has forced thousands of people to leave their homes to search for food while those remaining barely get by, surviving by foraging for wild food.

“Before the drought, I would feed my boys on camel and goat milk, but since the beginning of the drought, all the animals were moved in search of pasture. I only give what is available or in the extreme, we sleep hungry,” said the mother,

With the region plagued by perennial drought, and given that the mother has to fetch water for the family, she could not exclusively breastfeed them for six months as is recommended. They started taking porridge at two months.

At the screening table, using the Mid-upper Arm Circumference (MUAC), a simple coloured plastic strip used on children five years old and below to determine whether or not they are malnourished, the twins’ measurements pointed at the red zone, meaning they were acutely malnourished.

A measurement in the green zone means the child is properly nourished, yellow means the child is at risk while the orange zone means the child is moderately malnourished.

“They are even recovering. Early this month, they were worse,” says Mohammed Abdifatah, the nurse in charge of Sarman dispensary who was attending to the twins. He revealed that for the last four months, they have been admitting about 25 severely malnourished children per month.

“When we conduct our outreaches monthly, we are able to screen about 50 children and out of this, 20 who are under five are always malnourished,” he said. The situation, he added, is worsened by the fact that there is no hospital around. The dispensary is 25 kilometres from where the community fetches water.

“When they are unwell, they have to wait for the outreaches to get services. There is no hospital nearby, no means of transport and no mobile phones,” he said.

Malnutrition is a prevalent problem in Wajir County. In most of the villages we visited, we saw heartbreaking scenes of children with huge bloated stomachs and sunken eyes. In their eyes is deep, deep sorrow. The images of people extremely affected by hunger to the point they can no longer stand and the elderly who are skin and bone, were very disturbing.

In one of the villages, I asked a mother what they last ate. She said strong tea and half a kilo of rice shared by seven children. With even local fruits becoming scarce, people on the brink of extreme hunger in southern Wajir are surviving on leaves and insects and whatever else they can get.

“There is zero nutritional value in whatever they have been consuming for a very long time. This is the main reason for the high number of severely malnourished children,” Dr Eipa said.

According to a survey carried out in July and August, the nutrition situation in the county is critical at phase three, with a global acute malnutrition of 17.9 per cent. As a result, the World Health Organization (WHO) has designated Wajir among other counties as an acute food and livelihood crisis area.

The 17 per cent figure that is above the emergency threshold, which is 15 per cent, according to WHO. The severity of malnutrition, according to WHO, is only acceptable if the prevalence is less than five per cent yet more counties, Wajir included, have exceeded that by as much as 23. 3 per cent.

Wajir is one of the leading counties in terms of the number of severely malnourished children. The projected case load for children with SAM and MAM is 6, 314 and 45,062 with 14,940 pregnant and lactating mothers.

 “In the county, food security is classified as critical and many are in need of food to survive. Currently, milk consumption is below one litre, which is below the long-term average,” said county director of Health Dr Dahir Somow.

He said that a majority of the households are pastoralists and therefore the reduction in milk consumption will negatively affect the nutrition status of children under five years.

Morbidity, Dr Somow said, remains the key driver to malnutrition in the county, with upper tract infections, diarrhoea and pneumonia being the top three killers of children under five years. Malnutrition, he added, is often made worse by cultural practices. In some of the pastoralist communities, pregnant women are forbidden from taking crucial foods such as milk, eggs and meat.

Mr Abdullahi Aden, the Save the Children programme officer in Wajir, is responding to the situation in three sub-counties: Wajir West and North, and Eldas, reaching 97,000 households.

“We have registered 3,500 households who will benefit from a cash transfer programme, with each family getting Sh5, 000 for the next three months. We are also conducting support clinics in 75 villages where acute malnutrition treatment is given to children under five,” Mr Aden said.

 According to UN figures, about 700 million people globally are undernourished while at least 500 million are food-insecure, most of them in Africa.

According to the survey conducted in July/August, the nutrition situation in the country has remained within the same phase across the counties compared to the February analysis.

“Poor infant and young child feeding practices, food insecurity with reduced milk availability for children’s diet, poor sanitation and hygiene are the main sources of high malnutrition in the country,” said Dr Veronica Kirogo, head of the Nutrition and Dietetics division at the Ministry of Health.

According to the data, the Nutrition situation in the country is critical and some counties, such as Garissa, Wajir, Mandera, Samburu, Turkana, Marsabit and Baringo are in phase 4 while Tana River and West Pokot were classified as serious phase 3. Saku and Moyale sub-counties in Marsabit County were in alert phase 2.

From the findings, counties in the semi-arid and arid regions are leading with over 96,242 children who are severely malnourished, 368,985 moderately malnourished and about 93,400 pregnant and lactating mothers. Other areas have 31,668 severely malnourished and 97,928 moderately malnourished.

In the counties in urban areas, including Kisumu, Mombasa and Nairobi, about 14, 899 children of five years and above are severely malnourished and 43,238 moderately.

Wajir County has since started an integrated outreach in the most affected sub-counties. The county has allocated Sh100 million as cash transfer funds to 20,000 households.

“We are transitioning from food to cash to give them the dignity to buy what they want to eat. We are going to give Sh5,000 emergency money to the families in the three most affected sub-counties,” Disaster Management and Humanitarian Coordination director Abdikadir Hussein Alasow said.

He said that currently, about 200,000 persons in the county are in need of food and if nothing is done.

National disaster

“This is worrying since 80 per cent are pastoralists and both animals and humans are already fighting for resources,” he said.

Kenya recently declared the ongoing drought a national disaster, with at least 1.4 million people facing food shortages. The government has identified 23 counties that are mostly affected, and classified them into three groups. The first 10 are where both the cost of response and the risk of severe drought are high. In the second 10 counties, the drought risk is moderate and the cost of response is moderate to high.  The third group, consisting of Embu, Narok and Nyeri counties, are low risk.

In the reporting period, 20 out of the 23 of the counties reported that many households trek long distances to water sources, the same as the previous month.

The survey also highlights the poor condition of pasture in 65 per cent (15/23) of the counties compared to 35 per cent (8/23) counties in the previous month, with the decline attributed to poor performance of the March-May rainfall.

In milk production, 15 out of the 23 most-affected counties reported that production was below normal, and declining milk production is attributed to the poor rainfall performance of the 2021 long rains.

“The deterioration in nutrition status in children and pregnant mothers is due to reduced milk consumption owing to decrease in milk production compounded by fewer integrated health outreaches delivering essential nutrition services,” says the survey report.

Despite the complexity involved in managing cases such as that of Ibrahim and the twins, Wajir County relies on community health volunteers to detect and respond to acute and chronic malnutrition.

An inadequate number of nutritionists has presented a challenge in detecting the cases earlier. Wajir has less than 50 nutritionists.

The Health ministry says fighting malnutrition is majorly a county governments’ duty.