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Half-closed eyes, staring, Safa, 5 months, clings to life. ” She arrived with seizures and suspected meningitisdetails nurse Abdelkerim Djaranebi. We intubated her to help her breathe, but her vital prognosis is no longer at stake. »
In this unit of the Chad-China hospital reserved for children suffering from severe acute malnutrition in N’Djamena, the Chadian capital, death lurks. This morning at 10.02 a.m. she grabbed Hassan, also 5 months old, admitted to 5.2 kilos. He fought for ten days without gaining weight. Septic shock, his file says without further comment.
” The children arrive in such states of weakness that they can no longer eat and even the probe is an aggression for them. “says the nurse. Adam, he has already come a long way. After a respiratory cardiac arrest, the one-year-old child was resuscitated on April 26 when he was admitted. Monitored every thirty minutes for several days, his condition has stabilized but his body is still bruised by malnutrition. His skin shows burn-like lesions.
“When the child is undernourished, the cell weakens and the passage of internal fluids to the external causes edema and cracking of the skin. explains Ousmane Ahmat Mahamat, the unit’s supervisor. Adam suffers from severe acute malnutrition syndrome due to protein deficiency, kwashiorkor.
“It is a very worrying year”
It was necessary to push the walls of this structure managed by the NGO Alima and its Chadian partner Health Alert to accommodate all children under 5 who had reached this final stage of undernourishment. They are 104 on May 13, occupying every corner of the unit designed to accommodate a maximum of 60 children. Beds have invested the space usually devoted to games.
” It is a very worrying year, a state of nutritional crisiswarns Ousmane Ahmat Mahamat. In the previous three years, the peak of receptions began in the twentieth week, at the time of the lean period [qui s’étend de juin à septembre, le mois des premières récoltes]. This year, it started in the sixth week. »
Despite the dozens of mothers waiting at the door for their child to be picked up, management suspended new admissions that day. “It’s an extremely difficult decision to make. saddens the supervisor, but, given the saturation of the service, it is the only way to guarantee the quality of care. » The capital has a hundred beds scattered in three other structures authorized to receive these patients, but the care is chargeable. Not at Alima. Médecins sans frontières (MSF) will open its 100-bed reception in June, for a few months, as it does every year.
Chad, 16.4 million inhabitants, ranked 186and out of 189 on the human development index, is going through one of the biggest food crises of the decade. According to the United Nations, 4.1 million people are food insecure and 1.6 million children under 5 need nutritional assistance. A situation resulting from low rainfall, poor harvests and rising prices of basic necessities in the wake of the Covid-19 pandemic and then the war in Ukraine.
“When there is nothing, there is nothing”
In 2021, the three-kilogram bag of corn – a staple food – was worth 500 CFA francs; today he buys 800 CFA francs. The price of oil has increased by 65% and that of fish has doubled. The situation is particularly inclement in the capital of 1.8 million inhabitants where the prevalence of acute malnutrition is 10.3%.
” In the countryside, people can get by by cultivating a small plot of land, explains Claude Kiangala, head of mission for Alima in Chad. But in N’Djamena, wages have not increased despite inflation. When there is nothing, there is nothing. »
The poor security situation in the Lake Chad region since 2015 further complicates the situation. ” We are experiencing a lot of population displacements, specifies the Minister of Health, Doctor Abdoulmadjid Abderahim. These movements put pressure on arable land, but also on the already fragile health system. »
In the arms of his grandmother, Ali, 6 months, emaciated face and visible ribs, sucks desperately in the void. The mother, a 16-year-old girl prostrate in a corner of the bed, looks away from the child. ” She says she’s sick, explains Clarisse Bakalah, awareness officer in the therapeutic nutritional unit. ” If children were breastfed more, a large number of cases could be avoided, exasperated the midwife who deplores the anchoring of popular beliefs. We still hear that the mother’s milk is bad, that it gives diseases, that it can even kill. »
One in ten children dies before the age of 5
According to the WHO and Unicef, feeding the child entirely at the breast without additional water or other foods would help to stem neonatal and infant mortality. In N’Djamena, the rate of exclusive breastfeeding up to 6 months is 6.4%. However, many mothers, themselves malnourished, struggle to produce nourishing milk for their children.
It is noon. Suddenly, the atmosphere becomes less heavy and the crying subsides. Medical staff distribute milk and Plumpy’Nut, a high-calorie pasta made from peanuts provided by Unicef. Today it is the only ready-to-use therapeutic food dedicated to the nutritional rehabilitation of children over 6 months. But for several years, supplies have not been sufficient to cover all needs.
The UN agency has planned to distribute aid to 275,849 children in 2022, while the Chadian public authorities estimate that at least 343,087 would need it. At the end of each month, Alima must draw on her “buffer stock” financed by international donors, such as the European Union (EU) or the American NGO Edesia. ” Last year we received nothing between May and July, says Doctor Claude Kiangala. We have already been informed that there will be no more deliveries from October. »
Since 2015, the unit has been fully funded by the EU. ” We should have already withdrawn, because our mandate is to intervene only in emergency situationssays David Kerespars, head of the EU’s humanitarian aid office in Chad, but all I have to do is come to the hospital to resign for a year. We can’t leave the kids like that. »
As for the NGO Alima, it is also preparing to give up its place. Discussions have been initiated with the government for the hospital to resume operations. ” We are in a very embarrassing situation because the question of financing the salaries of health personnel is already a problem, worries the Chad head of mission for Alima. The needs are known, the peak periods also, the authorities must now take their responsibilities. »
Without an effective birth control policy – the fertility rate reached 5.6 children per woman in 2019 – and state investment in favor of self-sufficient agriculture that takes climate change into account, Safa, Adam, Ali and so many others will continue to confirm this dramatic national statistic: in Chad, one in ten children dies before the age of 5.