With the World Food Summit happening this week in Rome, and thinking about my experience of working in the field of malnutrition, two very strong images came to mind.
First, rewind 17 years to September 1992, to a feeding centre in Baidoa, Somalia. This was one of the most devastating humanitarian crises of the last 20 years. For MSF, a situation where one in ten thousand people are dying of hunger and related diseases constitutes a nutritional emergency. In Somalia in 1992, thirty people per ten thousand were dying as a consequence of war, mass displacement and failed food crops.
So, there I was standing in the heat of the day among hundreds of children lined up in queues clutching orange plastic bowls between their nervous yet expectant fingers. The problem was that it was very difficult to reach the children in the outlying villages. Those that did make it to the feeding centre had to stay until they reached a certain weight. One child, whom I shall call Amelia, was a typical patient – two years old and pencil thin. She was alone at the centre and, although she eventually gained weight, her progress was slow as her mother had to look after other children at home.
Since that time, our knowledge and approach to dealing with malnutrition has moved on. The advent of ready to use food, and general acknowledgement that severe malnutrition can be treated successfully at home, mean that we can avoid regimented responses to malnutrition like the one I experienced in Baidoa.
Now, rewind to Chhattisgarh, India in Spring 2008. Heavily pregnant myself, I spent one and a half days travelling to a remote part of central India, where I found a group of children living in a village in an area known for clashes between rebels and the government. The MSF team was attempting to reach people who had been isolated by the conflict, providing medical assistance including a mobile feeding programme for moderate and severely malnourished children. Compared to Somalia, where we had to line everyone up for treatment in a specified location, in India we took treatment to the patients.
Despite these developments, malnutrition is still not given fair attention in terms of its funding and pecking order within the global food debate. Whilst there is consensus on causal factors (such as the role of seasonal hunger) and an understanding that innovative approaches and a nutritious food package can meet the challenge, a lack of funding and priority means people around the world are still dying because they do not have enough to eat. And this indeed fills me with dismay.
Bev Collin is Health Policy and Practice advisor for MSF UK’s Programmes Unit. She is a trained nurse and anthropologist and has been field based on and off since 1992. She has worked as strategic health adviser for MSF in Amsterdam as well as field medical coordinator in various missions around the world.