(ROBERTO SCHMIDT/ AFP/GETTY IMAGES ) - A baby with acute malnutrition receives care at a hospital in Somalia, where thousands of refugees are seeking famine relief.
Two years of drought have left millions of people facing starvation in the Horn of Africa — more than 4 million in Somalia alone. Tens of thousands have died, and an estimated 750,000 are at risk of death.
About 36 percent of Somali children under the age of 5 are malnourished; nearly 16 percent are severely malnourished, according to that country’s Food Security and Nutrition Analysis Unit.
“It took me a week to say those malnutrition rates without having the hairs on my arm stand on end,” said Peter Hailey, a nutrition specialist with UNICEF in Somalia, in a phone interview. “In 20 years, I’ve never seen rates so high.”
The staggering numbers are not only challenging the resolve of responders to the crisis. The numbers are also the biggest test yet of recent improvements in assessing and treating malnutrition, changes that range from the coordination of care to the ingredients of food aid.
Less than a decade ago, almost all refugees arriving at a camp would go to large — but not large enough — hospitals.
Strategies have shifted, however, and in most camps refugees now start at a reception center. Workers there provide food, water and vaccinations, and they perform triage — assessing levels of malnutrition and diagnosing other conditions.
The most ill of the refugees are sent to a hospital for inpatient care, while those who are only mildly ill are sent into the camp itself and asked to visit one of many outpatient centers for occasional checkups.
“Before, we’d have 10,000 people headed toward a hospital, but you can’t run a hospital with 10,000 people,” said Susan Shepherd of Doctors Without Borders in Nairobi in a phone interview. “With [outpatient] treatment, we’ve been able to get to people earlier and better allocate resources.”
Part of ensuring the right care for the right people is objectively determining the level of malnutrition. For children from 6 months to 5 years old — the ages most vulnerable to the effects of malnutrition — workers at a reception center will measure a child’s height and weight and compare those to standards from the World Health Organization. A 3-foot-tall boy, for example, should weigh a little over 29 pounds; when severely malnourished, the boy might weigh 23 pounds or less. Workers can also measure the circumference of a child’s mid-upper arm; less than 115 millimeters — about 41 / 2 inches, a little less than the circumference of a golf ball — indicates severe malnutrition.
A test of appetite is also done, because children often lose their appetite when severely malnourished. If the child eats, he’s probably only moderately or mildly malnourished.
Hospitals then focus on the most dire cases of malnutrition.
Treating malnutrition
In images of the crisis, we see a few of the symptoms of severe malnutrition: emaciation, distended stomachs, fatigue and glazed eyes.
Without food, the body resorts to consuming its own tissue, said Nigel Rollins, a WHO pediatrician. A lack of nutrients can cause cellular damage that prompts water and other fluids to gather in tissue, particularly around the limbs. The abdomen might also swell because of an accumulation of fat in the liver.
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