MARADI, 26 July (IRIN) - The big white bandage round his head doesn't bother little Amissou as he takes small sips of protein enriched milk while his younger sister sings to herself beneath his bed.
A few days ago, this three-year-old victim of Niger's famine could hardly breath, let alone drink.
Amissou, who weighs just 5.8 kg, was severely malnourished and came close to death's door.
Now he is recovering in the intensive care ward of the Medecins Sans Frontieres (MSF) therapeutic feeding centre for malnourished children in Maradi, a town 600 km east of the capital Niamey.
"It really gives you a sense of achievement when you see a child who is matchstick thin and manages to put on a kilo of weight in less than a week," said Chantale Umotoni, the Rwandan nurse watching over him.
Umutoni has been working round the clock in the 64-bed intensive care ward for the past six weeks to keep Amissou and others like him alive, but she still feels emotional about the job.
"Sometimes you get desperate mothers coming in with children who are really ill and are nothing but skin and bone. You feel they are putting all their trust in you and you feel you simply have to do everything you can for the child," she said.
The MSF feeding centre is one of a growing number for malnourished children in this semi-arid country, that is ranked by the United Nations as the second poorest nation in the world.
Life has always been tough for Niger's subsistence farmers. Food shortages lasting several months in the "lean season" during the run-up to the annual grain harvest are nothing new.
But in 2004 the rural population was hit by a double whammy; a premature end to the rainy season and the biggest locust invasion for 20 years.
The fields of sorghum and millet were decimated and the sparse pasture which nomadic herdsmen rely on to feed their cattle disappeared, triggering a major food crisis.
Thousands have died
The United Nations reckons that 3.6 million people - nearly a third of Niger's 13 million population - will go hungry before the next harvest begins in October.
It also estimates that 2.5 million people are extremely vulnerable and require food assistance. Among them are 800,000 children who are already malnourished.
No-one has so far counted the number of children who have died of hunger in this country where three out of 10 kids die before the age of five anyway as a result of poverty and disease.
But Jan Egeland, the UN Emergency Relief Coordinator, told reporters in Geneva last week that several thousand children had undoubtedly perished this year for lack of food.
Young malnourished children and their mothers are the priority targets of international aid agencies.
"My husband is old and can't work any more, so I have to wear myself out to feed the family," said Haoua Ma'azoo, an aging mother of five with wisps of grey hair emerging from her bright red and yellow headscarf.
"But the locusts invaded and ate all our crops," she told IRIN as she waited for her young daughter Diatou to recover in the MSF feeding centre.
Ma'azoo decided to bring Diatou in after constant vomiting and diarrhoea caused the girl to lose weight. Now she sits smiling in the intensive care ward, her hair braided into tiny spikes.
The long walk to receive treatment
Most children spend only a few days in the feeding centre, but it never empties. More mothers and grandmothers arrive every day with a small child on their back seeking food and treatment. Many of them walk through the bush for up to 10 hours to get there.
In the admissions tent, a local nurse receives about 300 new arrivals every day, checking the height of each child against its weight to determine how badly malnourished it is.
Between 40 and 80 children per day are admitted as in-patients and are given a red bracelet. These are the severely malnourished cases.
The others, who are in slightly better shape, are simply given a food ration consisting of 25 kg of protein enriched flour and five kg of vegetable oil and sent home.
These outpatients are given an orange bracelet if they are moderately undernourished and at risk of deterioration and a yellow bracelet if they are in a less dangerous condition.
A few relief agencies, like MSF, have been operating in Niger for years.
But more began setting up aid programmes in July as television pictures of the starving children finally persuaded western governments to fund a large-scale famine relief operation.
Besides MSF, several other relief agencies have now set up operations around Maradi. They include Oxfam, Save the Children, the African Muslim Agency and the World Food Programme (WFP).
The WFP, which has just appealed for an extra US $12 million for Niger, aims to distribute free food to 1.2 million people across the country before the new harvest begins in two months' time.
Soaring food prices
Most of the famine victims have no money left and many have sold their farm implements, their livestock and even their jewellery to raise cash to buy food in the market that is becoming increasingly expensive.
In Maradi, a 100 kg bag of millet which normally costs 16,000 CFA francs (US $29) at this time of year now costs 28,000 CFA (US $51).
Even the aid agencies are finding it hard to buy food locally to distribute to the needy.
Neighbouring Burkina Faso has banned food exports to conserve stocks and food prices in Nigeria to the south are sky high, so many have resorted to the expensive option of flying the most urgently needed items in from Europe.
The African Muslim Agency, which is financed by Kuwait, is one of the newcomers to Maradi. Since the organisation opened its therapeutic feeding centre in the town on 12 July it has treated 203 moderately malnourished children - the severe cases it sends directly to MSF.
The feeding centre is situated in a sandy courtyard where about 100 women sit with their children in the shade drying sorghum flour and rice on mats in the hot sun.
The feeding centre provides five meals per day for children, mainly porridge and groundnut paste, and three meals a day for their mothers.
"What we need most in this emergency is food, equipment for the medical team and medicines," said Abdellak Azeroual, the local representative of the African Muslim Agency.
Medical treatment, but no food
Tragedies and small miracles are to be found everywhere.
Hassan Akil, a pediatric nurse at Maradi regional hospital, caressed a baby girl who arrived in convulsions an hour earlier.
Her mother didn't have the money to pay the standard 700 CFA ($1.30) medical consultation fee, but the hospital staff took pity on the 10-month-old infant who weighed just 3.7 kg and admitted her anyway.
Now she has an oxygen tube in her nose and an intravenious drip in her arm.
The child's mother, Maimouna Alassane, explained that her child was getting thin and was suffering from vomiting and diarrhoea because there was not enough food to go round at home.
She had taken her baby to the MSF feeding centre, but there they refused to admit her for treatment, saying she was only moderately malnourished.
The irony is that while the hospital can provide medical treatment for the baby girl, who is being admitted there for the second time, it can't feed her.
"We have got the necessary drugs, but we don't really have the means necessary to deal with malnutrition," said Ikal, the pediatric nurse.
"This year is special," he said. "There is more malnutrition around than in other years because the harvest was not good."
He is encouraged by a good start to the current rainy season, which began in June and has already sent green shoots of millet and sorghum sprouting through the soil in ploughed fields.
"If there is a good harvest there will be enough food for the mothers to eat and they will be able to produce milk to feed their children," he said.
But if the harvest fails again, Ikal warned, the misery will continue.
"It doesn't necessarily mean people are going to die, but it will lead to more malnutrition," he said.
While aid money to help the famine victims of Niger has started to pour in, it is still not enough and other less publicised food crises await to be properly addressed in other countries of the Sahel such as Mali and Mauritania.
The UN Office for the Coordination of Humanitarian Affairs (OCHA) recently doubled its Niger appeal to US $31.1 million and has warned that it will soon raise it again.
One UN official working on plans to tackle the famine crisis in Niger noted that the current UN appeal only provides for 300,000 malnourished children under the age of five to be fed.
That still leaves half a million who are uncatered for, he warned.
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