Malnutrition: "It's among the worst I've ever seen"

There are lots of cases that stand out from my time in Ethiopia, but there's a few that stand out more than others. We had one little girl, only 18 months old, who arrived severely malnourished. If her family hadn’t brought her to the hospital, I don’t think she would have survived. But I'll come back to her later.

In fact, I’ve worked with MSF for over ten years, and the levels of malnutrition I saw in Shire were among the worst I’ve seen.

In Ethiopia, there are several reasons why families are struggling.

Huge numbers of people have been displaced by armed conflict. There are significant problems with drought and changes in the climate. Both those things are factors in escalating prices and scarcity of resources. All this means that families are finding it really, really tough to feed themselves and their kids.

As MSF, we treat malnourished children in special hospital wards. In Shire, ours was always full, and often over capacity with patients needing help.

We've also been using mobile clinics, where teams travel to local villages and communities, or to camps where displaced people are living. We assess the children for malnutrition, provide treatment, therapeutic food and ongoing monitoring.

The most critically ill children are then admitted to the hospital.

More than hunger

Malnutrition isn't just about hunger. Once a child has become malnourished, their immune system is weakened and they can't fight off infectious diseases as they would normally.

So it's not just about providing food. They need medical care and specialist expertise. They need to be stabilised, they need antibiotics, they need fluids.

On top of all this, they need vitamins, specially formulated therapeutic milk or food, and vaccinations to protect them against further infection.

All of this is what MSF is able to provide.

The malnourished 18-month-old who we admitted to our hospital had arrived extremely anaemic, with pneumonia, and a severe skin infection. "Anaemia" means low levels of haemoglobin in the blood, which is needed to transport oxygen to the body’s tissues. In extreme cases like this one, it is life-threatening.

This little girl’s haemoglobin levels were so low she needed a transfusion. We gave her blood, we gave her food, we gave her antibiotics and treated her infection.

Alongside the medical care, psycho-social support is key for young patients and for their parents.

There's a lot of shame associated with malnutrition and not being able to feed your family. And so we work to give a lot of parents support, to get them through it, to just be a human about it. To care for them, to show them that, actually, it's nothing they've done wrong.

To see a lot of the parents turn around, too, to see them come back to life and realise that, actually, there is a little bit of hope... it is just wonderful.

The best feeling in the world

After a few days, the 18-month-old bounced back. She went from being in a critical condition to being a smiley, playful little girl. It was like seeing a completely different child.

With the right treatment you can see dramatic improvements in malnourished patients quite quickly. It's really amazing to see their little souls just emerge, they start to come alive again.

It’s a really special feeling to get to the point where you can say, “you don't need to be in hospital anymore. You can go home, you've beaten it, you've done it.” I can't describe it.

To see families walking out of the hospital together is the best feeling in the world.

In numbers: Our work on malnutrition

Malnutrition crises are happening around the world right now, in parts of Niger, Nigeria, Somalia and South Sudan. MSF teams are working in all of them.

Children dying of malnutrition in 2023 is unacceptable to me. As a doctor, going out to these areas and seeing and treating these children, it's heartbreaking – to witness, to listen to what they have had to survive.

Above all, it’s heartbreaking to know children are dying from something that can be treated. Because, in the end, we know that we can do a lot with very little.