Two inseparable elements are combined in MSF’s work: medical aid and witnessing (témoignage)’. Witnessing consists of being present among the population, being motivated by a concern for their fate as human beings, and listening to the people. Intertwined with the act of witnessing is the responsibility to report on the situation and on the fate of the people. In working with MSF in Niger, I am realizing that this might be the greatest responsibility I have ever had.
Famines are largely avoidable phenomena that do not arrive overnight. They are not like earthquakes or hurricanes that suddenly appear with no warning, they cannot even be considered as purely natural disasters. I am currently bearing witness to an impending famine, and it fills me with a complex mix of fear, dread, the hope that I can do something, and the knowing that no response will be sufficient, regardless of what I do.
The region of Niger where I am situated has now experienced 2 consecutive years of meagre harvests. The most recent harvest was decimated by crickets, and the previous year had seen horrible yields due to drought. Security reasons greatly restrict the movement of westerners in Niger. Due to the nature of my work, I am the only MSF expatriate in the region who is allowed regularly to venture into the far reaching villages. I am therefore the only expat truly able to bear witness to the current development of the food security problems.
Several times a week I visit a number of remote rural villages of southern Niger. In these villages the diet typically consists of only millet porridge. It is a great rarity to find someone who eats anything besides millet on an average day. In Niger, as in many other countries, there is a traditional lean season - “the hunger gap” - between the time when the staple stock is exhausted and the new harvest arrives. In Niger this season usually occurs in June or July, and the harvest is cultivated in December. It is now the beginning of April and the village chiefs consistently tell me that the millet stocks are extremely minimal, if not completely exhausted already, there are no seeds to plant in the summer, and that most of the village men have left for Nigeria in search of work. Passing through the villages this is obvious: few men, except for the old, are seen. Annually, there is a seasonal migration of men towards Nigeria, however; it usually happens much later in the year. Their return coincides with the planting season, but without seeds there will be no planting season this year. The malnutrition rates will only increase. Village chiefs are responsible for the health of their people, they can see the oncoming calamity, and they plead with me to pass on their people’s plight to those who can help.
My work with MSF involves supervising and coordinating a project which focuses on preventative and curative care in these villages. We train local people to treat basic childhood illnesses, and we provide them with the essential medication for the treatments. We have a network of villagers who do health promotion about breastfeeding and hand washing in the villages. But without food, all of these actions have limited effect. While in the field, we regularly encounter children needing to be transferred to the inpatient malnutrition centre. Transfers consistently fill me with awe – the act of putting a mother and a child in a land cruiser and taking them to the ‘big village’ to be treated is simple. However, it is usually the first time either one has ever been in a motorized vehicle, and the whole experience must be extremely over-stimulating for them. Despite my never-ending curiosity, I try not to ask too many questions, as the mother is usually either overwhelmed with nausea, or in the process of vomiting. The other day our team transferred a woman with her severely emaciated daughter to the malnutrition centre. This mother wanted to talk. She cried and told us that she wants to be a good mother. She wants to treat her children well. She knew her child was becoming malnourished, but she didn’t know how to stop it. This story is repeated throughout the villages. Without food one cannot stave off starvation.
I wonder, on a daily basis, what is required for other international actors to act. Everyday more and more children arrive at the ambulatory or inpatient malnutrition centres that MSF run, often in such poor state that, despite treatment, they do not survive the first few hours of hospitalization. Do we have to wait until enough children die, or enough malnourished children beyond the ‘normal’ amount are admitted, to declare an emergency? And why is it that more energy will be spent in responding to the crisis than was ever put into preventing it?
2010 was the worst year on record in Niger in terms of malnutrition, with over 318 000 severely malnourished children being admitted to therapeutic feeding centres throughout the country. Considering the inexistence of grain reserves from 2010, and the poor harvest from the current year, many NGOs have predicted that the situation in 2011 will be dramatically worse than that of 2010. In the villages, the people aren’t predicting. They are clearly stating that the food security situation is worse than it was in 2010. With no seeds to plant, this is only the beginning of a disaster. As I might be the only expatriate present in the villages, they are asking me to share their pleas for help with whomever may listen.
I hear the stories almost daily. I see the children that are becoming malnourished and this is not because of their mother’s ignorance or negligence. I see a population wanting to stop the oncoming disaster from occurring. I hear them crying out for help. I hear them crying out to be acknowledged as people that have a right to life, and a right to access adequate food. And it is my responsibility to pass on these cries. I don’t have numbers, the numbers will come too late. But I do have a great responsibility, with many lives at stake.
I fear that my appeals will be muffled by the other cries throughout the world at this time – the voices coming from Libya, Japan and all of the other countries presently in crisis. Malnutrition is endemic in Niger, and I fear that the deaths of thousands more malnourished children in Niger in 2011 will simply be seen by the international community as the continuation of an ‘ongoing crisis’. But these are people, these are children, and each one has the right to live. Their deaths can be prevented.