Fatew Ahmed is getting better. In the past three weeks, she has recovered from pneumonia and gastroenteritis and she has gained two pounds.
Still, the 5-year-old orphan has an ancient face and eyes that do not seem to reflect light. She has marasmus, a condition of progressive emaciation known as "old man's syndrome." Her legs and arms are like broomsticks, the muscles wasted around elbows and knees that seem much too big. She has no buttocks, only flaking folds of skin. Her hair is dry and brittle.
When she is not eating, she curls up in a fetal position, and, for hours, does not move. She does not speak.
Fatew Ahmed is one of 10,000 children under 6 years of age here in a feeding center that has almost squeezed out what used to be the marketplace of this village 8,000 feet up in the dun-colored mountains of central Ethiopia.
More malnourished children are concentrated here in less space than in any place in the country. While they are eating far better than they could back on their parents' drought-scorched farms, the children here are ill-housed, ill-clothed and they are giving each other infectious diseases. North of Korem on a large flat plain surrounded by mountains is the main feeding center. It has a population of about 45,000 people, nearly a third of whom have no shelter. But most of the children are here at the marketplace and it is the children who are dying in Ethiopia's famine.
According to the U.N. Children's Fund, or UNICEF, about three-quarters of the 300,000 people who have died in Ethiopia in the past nine months have been under 4.
Fatew sleeps in the hospital ward -- a corrugated metal shed with a dirt floor -- on a full-sized bed made of stone. She shares the bed with her two sisters, her brother, three other children and their mother. The ward, which smells like a hog barn and echoes with the coughing and crying of children, has 300 patients. All have sleeping accommodations like Fatew's.
Fatew is given about 5,000 calories a day of rice porridge and a high-energy drink made of milk, butter oil and sugar. That would be plenty of food to help her gain weight, but, like most of the marasmic children in Korem, Fatew must share a lot of her food with her siblings.
While she is now free of disease, her doctor -- one of three doctors for the 10,000 children -- is certain that in the month and a half it will take Fatew to overcome the effects of marasmus she will again contract pneumonia and gastroenteritis.
Such is the state of relief in the Ethiopian highlands after more than a month of world attention to a famine that threatens the lives of 7 million people. The United Nations estimates that more than 325,000 tons of food have been pledged to Ethiopia for the next 12 months. Hundreds of thousands of people, touched by television footage of hungry children like Fatew, have donated money and clothes to relief agencies working here.
Yet doctors here in Korem say the number of hungry children is overwhelming their slowly increasing resources.
"I don't know who is who; who is an orphan, who is not; who is eating, who is not," said Dr. Azeb Tamrat, a French-trained Ethiopian physician who donates her time to the feeding center. "All of the children have parasites in their guts. They are spreading disease to each other."
Officials of Save the Children, the British organization that runs the marketplace feeding center, say it is short of hospital buildings, tents, plastic lean-tos, beds, blankets, clothing, firewood, kerosene, vaccination supplies, doctors, nurses, laboratory technicians and food delivery trucks.
While truckloads of food usually arrive daily, there are frequent supply interruptions. Chief nutritionist Kathy Bogan said that as of this morning the feeding center was down to a two-day reserve.
Save the Children had planned to move out of the overcrowded marketplace site in December and open a new feeding center north of Korem. But now there are too many children and both sites will have to be used. Since famine is far more lethal among children than adults, the marketplace feeding center tries to give children three or four times the 500 calories per day that adults receive at the main Korem camp. There are thousands of young children there, too, but there is no room for them at the marketplace center.
On starvation diets, children under 6 are prone to two malnutrition syndromes that increase their susceptibility to infectious diseases. Here in the highlands, where children have been hungry for years because of four seasons of drought, doctors say the most common syndrome is marasmus.
Fatew is one of the most emaciated children in the camp. Yet, like many marasmic children in the highlands of Wello and Tigray provinces, she has surprised her doctor with her capacity for bouncing back.
"This is a rehabilitated child," said Dr. Tamrat, holding Fatew in her arms. The girl weighs 21 pounds, less than 70 percent of normal for Ethiopian 5-year-olds. "She is now free of disease and in a month and a half, if she could avoid infection, she would be well."
The second, rarer and more life-threatening syndrome of malnutrition among children is called kwashiorkor, a Ghanaian word meaning "red boy." Kwashiorkor children often have reddish hair and skin and bloated bellies. The syndrome is caused by a lack of protein in the diet, although doctors say the exact mechanism causing the reddish colorations is not known.
Children of the highlands rarely have kwashiorkor, but it is cropping up in more fertile, low-lying farm areas in Ethiopia that have been hit this year with a sudden scarcity of food, according to Rhonda Sarnoff, a nutritionist who is Catholic Relief Services director for public health in East Africa. She said cases are being reported in Shewa Province, just north of Addis Ababa, and south in Sidamo near the Kenyan border.
"These kids are not used to hunger and when they do become malnourished they are difficult to treat. They lose their appetites. With these 'yellow kids' sometimes muscle tissue atrophies in the heart and the liver can get clogged with fat," Sarnoff said.
For children with either marasmus or kwashiorkor, as well as all severely malnourished children, there is a danger of brain damage if the lack of food occurs during the first year of life. Among older malnourished children, doctors say the body will metabolize fat, muscle, skin and internal organ tissue before the heart and brain.
After surveying a sample of the worst-off of the more than 100 feeding centers in Ethiopia, James P. Grant, the director of UNICEF, said last month that "clearly there will be a generation of Ethiopians who will be stunted physically and mentally."
Grant estimated that 500,000 children will carry the effects of this year's famine through their lives. At Bati, a village 100 miles southeast of here, where a new feeding center has mushroomed to a population of 25,000 in the past month, about 80 percent of the 100 people who die each day are children.
Dr. Miles Harris, medical director for the Red Cross at Bati, said this week that even among children older than 1 he "cannot believe that anybody who has been so malnourished could not have some brain damage."
The long-term effects of malnutrition for young children are just as likely to be psychological as physical, said nutritionist Sarnoff.
"When a child is starving and his mother is starving, they don't move except to eat," Sarnoff said. "There is almost no social development for these children."
Despite the possible long-term dangers of malnutrition, doctors and nutritionists in Ethiopia say what is most surprising about the children in the feeding centers is how quickly they recover.
At the Korem marketplace feeding center, the vast majority of children, although they have parasitic infections, appear healthy. From a distance, the marketplace sounds like a large waterfall, with thousands of high-pitched voices babbling and chanting.
In the center, the children are friendly, quick to smile and hold a stranger's hand. Save the Children allows orphans to be "adopted" by young mothers who have lost their babies. This week in one of the three orphan tents in the marketplace, the adoptive mothers were playing tambourines and singing with their new-found children.
One mother, Asmara Mohammed, had dressed her 2-year-old adopted son, Hadass Tegegne, in the clothing her own son was wearing when he died last month. For much of the afternoon today, Asmara and Hadass danced together in the orphans' tent.
"There is great joy here," said Dr. Tamrat. "There are just too many children."