In the outskirts of Moussoro, the main town in the western Chad region of Bahr-el-Ghazal, mothers line up with their babies in the sweltering heat waiting to be screened for malnutrition. In another area in the region, women load their donkeys with millet and groundnut seeds - provided by aid agencies in anticipation of better rains this season.
"This is the planting season, I will plant the millet first and when rains come I will plant the other seeds," Khadija Oche Youssuf, a mother of four, told IRIN in the northern village of Toumia, 60km from Moussoro. "We last harvested in September 2011 and the food finished; the harvest was not good because of the lack of rains and the locusts and birds."
Before they started receiving food aid, Toumia residents coped by cutting down trees and selling firewood by the roadside in the already fragile and degraded environment.
"We were then going to Moussoro to buy food," said Khadija, adding that the trip to Moussoro takes three days by donkey.
Bahr-el-Ghazal region is among the areas of Chad lying along the crisis-hit Sahelian belt, which stretches from Senegal to Chad. Like in the rest of the Sahel region, a mix of drought, poor rains and harvests as well as rising food prices have resulted in food insecurity and subsequent malnutrition.
At the main hospital in Moussoro, severely malnourished children with complications such as infections, diarrhoea and malaria, are attended to, having been referred from health centres further inland.
"I noticed that my baby was having diarrhoea and brought him to the hospital," Fatuma*, an 18-year-old mother of an 18-month-old baby, told IRIN. After three days at Moussoro Hosiptal, the baby's health is improving; at home the baby shared the family's food comprising mainly rice and maize meal.
Chad's "embryonic" economy is among factors limiting the local diversity of food sources and income, notes USAID's Famine Early Warning Systems Network (FEWS NET), adding that sociocultural care practices and poor health systems are also to blame.
Fatuma told IRIN she had first opted for her baby's uvula (fleshy extension of the soft palate which hangs above the throat) to be cut by a traditional doctor, hoping this would improve the baby's health, before taking the baby to hospital.
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Moussoro Hospital does not have a full time doctor. "We have eight nurses who have a heavy workload; they take care of the severely malnourished children, prepare meals and take care of the sick [in the general wards]," Phillippe Tadjion, the medical coordinator, told IRIN, adding that there is a need for more staff.
But even with the best treatment, for some children it is too little, too late.
"Almost 5 percent will die of complications from malnutrition while in the [treatment] programme," Richard Currie, a medical coordinator with Médecins Sans Frontières (MSF), told IRIN by email. "As you can imagine, the death rate for the thousands of children who do not have access to a therapeutic feeding programme is only going to be considerably higher."
MSF is addressing malnutrition primarily in the Sahel region of Chad but is also actively screening areas throughout the country for alarming rates of malnutrition. In one of its projects in the Salamat region, slightly south of the Sahel, "an area where one would otherwise expect adequate rainfall, an adequate harvest, and an absence of malnutrition, the reality on the ground, however, is quite different," Currie said.
In just one site in Salamat, MSF has admitted almost 4,000 severely malnourished children into its programmes in 2012 - in 2011 just over 5,100 children were admitted. "As the worst of the `hunger gap' approaches, we have over 50 critically ill malnourished children in our hospital at the moment," he added.
According to Currie, there are a number of reasons why an otherwise `safe' region might fall into a nutrition crisis, such as the diversions of harvested crops to more affected areas of the Sahel. "The situation in Salamat emphasizes that the global understanding of the nature and causes of the Sahel crisis - and our ability to predict its evolution - is far from easy," he said.
Many of the high-risk children live in rural areas without access to medical care. When the rains start, reaching them will be harder. "Proper roads don't exist or where they do, they become impassable due to mud or they cross a wadi that is a raging river in the rainy season," he explained. "It is tremendously rewarding to discharge a previously critically ill child from our programme as 'cured', but in the absence of adequate nutrition in the home and an improved food security situation in the community, the child remains at risk of falling back into illness later and eventually re-entering the programme."
High food prices
In May, at least 2.4 million people, mainly in Chad's central agro-pastoral zones of Guera, Kanem, Bahr-el-Ghazal, Batha and Sila were classified as being in the "stressed" food insecurity phase, with the lean season having started two months earlier than usual. Under the "stressed" phase, household food consumption is reduced but minimally adequate without having to engage in irreversible coping strategies.
"A lot of animals have died especially sheep and goats. Some camels have also died," Koisse Bichara, an auxiliary veterinary officer, told IRIN in Toumia. "Most of the other animals are far away and it is not easy to get milk, it is also dry."
Koisse said at present 1.5 litres of camel milk is selling at 1,000 CFA (US$2) - double the normal price. "At this price, the quantity is not enough. Who will drink [the milk] - the father, the children or the mother?"
The 1,000 CFA price, she added, is just for the sale of milk to the local population - visitors have to pay more.
Rains that have started earlier than usual in the regions of Guera, Salamat and part of Chari Baguirmi are expected to improve livestock body conditions as well as the population's purchasing power in the coming months, according to FEWS NET. However, cereal prices, which rose between March and May and are higher than the five-year average due to high demand, are expected to continue to rise until the September harvest.
The UN World Food Programme (WFP) aims to assist at least 1.5 million people in Chad, among them children younger than two years and their mothers. In addition, more than 205,000 schoolchildren will receive school meals in 2012. In April, the UN Children's Fund (UNICEF) also launched a three-month programme to distribute Plumpy'Doz, a highly nutritious therapeutic food, to 200,000 children aged 6-23 months. UNICEF estimates that at least 127,000 children will be at risk of severe acute malnutrition in Chad in 2012.
NGO Intermón Oxfam is involved in activities such as general food distribution, cash transfers, cash for work and the provision of seeds and water as well as hygiene services, according to its emergency response manager, Christian Munezero.
At present though, not all of the needs are being met.
On 19 June, humanitarian organizations appealed for $1.6 billion to help 18.7 million crisis-affected people - up from 16 million - in the Sahel. The appeal reflected an increase in the population in need in countries such as Chad, where between January and April the number of food insecure people shot up by 125 percent to reach 3.6 million. The 2012 Consolidated Appeal by humanitarian agencies for Chad had estimated that 1.6 million people there would be food insecure due to below average 2011 harvests and erratic rains.
Land-locked Chad faces logistical challenges when it comes to moving food aid, notes WFP. The crisis in Libya has also affected local trade with northern Chad, while radical Nigerian Islamist group Boko Haram activity in northern Nigeria has also slowed down trade in neighbouring western Chad and Niger.
The Chadian government has announced the subsidized sale of cereals but aid officials say more needs to be done.
"It is true that the government recognized the crisis... and announced a certain number of measures, but they remain declarations," said an aid official who preferred anonymity.
"We need to work better on the causes of the [food] crisis - not only the consequences because there will always be drought in Chad," added Oxfam's Munezero.
"...Malnutrition is a real problem of public health care, which requires medical and nutrition measures and should be integrated into primary health care, such as vaccination," said MSF's Currie.
*not her real name
*This report was amended on 26 June 2012
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions