Twin girls Hassana and Ousseina weighed less than 1.5 kilograms each when they came into the world a month ago. Now, after 18 days in the central hospital of Maradi in the far south of Niger, they have almost doubled in weight, even though they still look tiny and extremely fragile.
Nutrition expert Eric-Alain Ategbo of the United Nations' children's organisation Unicef issues a warning to visitors before they see the young patients. "What you see in these hospitals is shocking, and most visitors suffer nightmares for nights afterwards," he says. The babies in the hospital in this drought-struck part of West Africa are skin and bone, with no sign of muscle tissue.
Scientific evidence indicates that the first 1,000 days of a child's life are crucial for its future development. "This window of opportunity begins with conception and extends to the end of the baby's second year," the German Welthungerhilfe aid organisation says on its website.
If the baby does not have proper and sufficient nourishment during this phase, the likelihood of irreversible health damage is extremely high. This includes a weakened immune system, as well as physical and psychological damage. The drought across the Sahel has hit Niger hard, with 300,000 children being treated for severe malnutrition. A further 500,000 do not have enough to eat. "These are the kinds of numbers that you generally find only in war zones," Ategbo says.
"The consequences are different to those from other diseases. The children pay the price their entire lives," he says. Zaharia is already paying that price. She is two years old, but weighs just 7.2 kilograms, against a normal weight of around 12 kilograms. Her head looks too big for her body. Despite the oxygen she is given, she breathes with difficulty.
"Zaharia is not only malnourished, she also has tuberculosis," paediatrician Moustapha Boulama Ari says. The hospital is currently treating 55 children, whose distended stomachs, huge lifeless eyes and protruding bones raise questions about how this can be taking place in a world of plenty at the beginning of the 21st century.
Climate change is being blamed as one of the major causes. Where droughts used to occur every five to 10 years, the last one in this country was just two years ago. A sharp rise in food prices and poor economic management by previous governments are exacerbating factors.
"Right up to the military coup two years ago, we were not even allowed to talk about malnourishment. It was all but impossible for us to help the people," Ategbo says. "Now, under the new President Mahamadou Issoufou, there is at last agreement that the country has problems." For a couple of years now, there has been an effective treatment for starving children: therapeutic pre-prepared nutrition.
This miracle cure that could secure the children's long-term health is being marketed under the names Plumpy'nut and PlumpySup. They were used on a large scale during the recent famine in the Horn of Africa, saving the lives of many Somali children.
Both are enriched peanut-based pastes with added milk powder, vegetable oil and sugar, enriched with vitamins and minerals. A 90-gram pack contains 500 calories. Plumpy'nut is used in acute cases and PlumpySup in less severe ones. "It takes six to seven weeks until a severely malnourished child is again healthy using the pastes," Ategbo says.
The big advantage is, that the children can be treated at home. Unicef and the UN's World Food Programme are distributing the products from 1,500 health centres across Niger. The hospitals in Maradi and elsewhere are left to cope with severe cases - children with only a minimal chance of survival if they do not receive immediate medical treatment.
The doctors also aim to bring the mothers back to health by providing food, so that they are able to nurse their babies. Infants like Hassana and Ousseina are receiving supplementary feeding. "In the current crisis, it is especially important to take a unified approach," Ategbo says. If the food situation does not improve in the family home, the children will soon find themselves malnourished again, he explains.
"But here in Niger, we are better prepared than in the Horn last year, as the drought crises have become chronic here." Yet if donor countries cut back on donations and aid, efforts to fight malnutrition will soon be cancelled out - with the main victims the children, aid workers agree.