Like almost all workers, staff in the hospital at Ifo refugee camp amid the semi-desert of northeastern Kenya have their good and their bad days. But in the fight against child malnutrition, they say the good outnumber the bad.
"Nutrition is one of the most satisfying fields," said Dr. Ibtisam Salim, doctor in charge of the hospital in Ifo camp, one of three refugee camps near the town of Dadaab that make up one of the largest, oldest and most over-crowded refugee sites in the world.
"If malnutrition comes in through the door, it's usually good, because we know it can be cured. We do therapeutic feeding and treat the illness. Kids who are skin and bones and weigh three kilogrammes quickly become healthy weighing seven kilogrammes," she added.
In January, for instance, total admissions to the unit were 39 children. Twenty-nine were discharged to the outpatient therapeutic care programme; four were removed prematurely by a parent or another adult who accompanied them to the hospital. And one child died.
WFP provides food for family
UNICEF gives the hospital, funded by the German development enterprise GTZ, plumpy'nut and the UN refugee agency special milk. WFP provides food for the family member with the child to encourage them to keep the child in the unit for the full course of treatment.
WFP, UNICEF and UNHCR led a campaign last year to bring chronically high child malnutrition in the Kenya camps down to the lowest levels in years.
But some children still die every day in the Dadaab camps. Saad Siyat slipped away in the nutrition stabilization unit on 2 February at the age of 19 months.
Arrived too late at hospital
Brought by an aunt to the hospital three days earlier unconscious with severe pneumonia, a 40 degree Celsius temperature and convulsions, Saad steadily worsened. "This is something that happens when kids arrive too late at the hospital," said Dr. Salim.
When Saad suddenly started gasping for breath, Dr. Salim arrived at his bed and with quiet efficiency gave his tiny chest a cardiac massage with four fingers. Sufficient oxygen wasn't reaching his brain, and it began to die. She gave him injections and pumped a resuscitator to push air into his lungs. She checked his pupils for dilation.
Finally, Dr. Salim moved away while nurses pulled lines from Saad's left arm. She stepped outside and wept quietly. Saad's aunt pulled his ragged clothes together and covered him with a blanket.
Malnutrition encourages disease
Dr. Salim, 28, who has worked in the Dadaab camps for only two months, identified diarrhoea as the leading killer followed by pneumonia. "Malnutrition sets up a good breeding ground for anything," she said.
One of the problems is that many refugees avoid the hospital because of traditional myths about modern medicine.
The camps are home to nearly a quarter of a million refugees and some 700 children are born in them each month. In 2008, they received 62,000 new arrivals from Somalia - nearly half children.