After a delayed reaction from the international community, funding to combat a famine in Niger is finally beginning to arrive. But in the landlocked country's most heavily affected areas, there is little sign the crisis is abating, and some aid workers say things will likely get worse before they improve.
There is not enough room under the protective awning just inside the entrance of aid agency Doctors Without Borders' emergency feeding center in Maradi. The organization has had to build an additional shelter outside. And still, many of the several hundred women and small children waiting to be admitted to the facility huddle together in what shade they can find, the sparse trees or the shadow of the camp's office.
Medical staff here use a triage system, looking for the worst cases of malnutrition among the youngest, most vulnerable children, and bringing them in, one at a time, for an initial medical exam.
Since the beginning of the year, the medical relief organization, known by its French acronym MSF, has treated more than 14,000 severely malnourished children in Niger. This year, the doctors say they expect to treat more than three times as many children as they did in Sudan's war wracked Darfur region in all of 2004.
Laure Souley has come here with her three-year-old daughter and an infant son, whom she carries on her back.
She says she works in the fields near her village. Last year, she says, there weren't enough rains and, in some areas, the harvest was a disaster.
Locusts also caused considerable damage to Niger's always-meager crop of millet and grain last growing season. That was followed by rains that ended much too early, worsening the situation.
The U.N. World Food Program now estimates that more than 2.5 million Nigeriens are at high risk of severe malnutrition.
After a delayed reaction to the crisis by donor countries, sufficient emergency aid has begun to arrive only very recently.
Ms. Souley sits in the MSF admissions tent with her daughter Chapaatou, 3, crying in her arms. Chapaatou's body is skeletal. Flies crawl around her infected eyes and nose. Her hair is falling out.
Chappatou is weighed and measured by a team of nurses. She weighs just over five and a half kilograms and is just 72 centimeters tall.
MSF, which usually operates in areas of severe medical crisis, opened its feeding center in Maradi in 2001. Niger suffers almost annual food shortages. But this year, says one of the center's medical staff, Dr. Chantal Umutoni, things are much worse.
"The majority of pathologies we have here [are] severe malaria, anemia, diarrhea, and respiratory infections," said Dr. Umutoni.
Malnutrition, Dr. Umutoni says, often makes routinely treatable illnesses fatal. In the intensive care ward where Dr. Umutoni works, a child died the previous day.
"Often there are some who came late and we lost them. Maybe from malaria, from diarrhea. And if they were coming earlier, we could have saved them. And I think that is the most difficult thing to cope with," she added.
Young Chapaatou Soulay receives here medical checkup. Blood is taken for a malaria test. A nurse listens to her heart and lungs through a stethoscope.
Her mother says she has been running a high fever for nearly four months. Nurses say she is negative for malaria and respiratory infection. But they say she has infections in both eyes. And when they try to feed her, she breaks into painful sobs.
Chapaatou is among those who will be admitted to the center. Due to the limited capacity of the Maradi center, nurses say, around 40 percent of children have to be turned away.
In Maradi, Doctors Without Borders is building new tents in its camp to accommodate more children. MSF France's country director in Niger, Johanne Sekkenes, says the mission there is one of the most successful MSF has ever organized.
"We have highly qualified medical personnel. We also have the products needed to take care of these children. We have a strategy of the hospitalization of the severest cases. And also a strategy of treating the severely malnourished children in outpatient clinics," she noted. "All these factors, they help to have a very good cured rate. Eighty-five percent of the children admitted to the program, they will go home healthy."
But, Ms. Sekkkenes says, despite the aid now pouring into Niger, for many this assistance has come too late. For others, she says, the future remains uncertain.
"I see the situation as very serious. And we know that the coming weeks are the most difficult weeks of the year, every year in Niger. It's the rainy season. There's the diseases that come with the rainy season. It is also the weeks just before the next harvest. There's, if any reserves, food reserves, left in the villages, they're very low," she explained.
The World Food Program (WFP) plans to begin free food distributions in the worst hit areas this week. It is appealing for nearly $60 million of food aid to combat the food crisis. The United States has pledged more than $13 million in aid to Niger so far this year.