How Action Against Hunger Averted a Famine in Mali

In March 2005, Action Against Hunger alerted Mali's government that a nutritional crisis was looming. Our Global Information System (GIS) warned us of trouble ahead. GIS produces a computerized analysis of such factors as available pasture, population movements, water sources, social services, malnutrition rates, and so on. It integrates this complex data, maps problem areas, and suggests solutions.

In the wake of a drought in Mali and a plague of locusts, our analysis said the government should prepare to:

• Provide drinking water and food to threatened communities at minimal or nocost to the recipients.
• Monitor local health conditions to forestall outbreaks of diseases.
• Prepare to care for a rising number of malnourished children.
• Provide feed for livestock.
• Supply water in dry pastures.
• Monitor herds of livestock for disease.
• Provide temporary employment for herders who lose their livelihoods.
• Help farmers thin their herds strategically and preserve the meat.

At the time, Action Against Hunger's nutritional surveys found rates of global acute malnutrition (GAM) of 15%—and internationally, a rate of 10% constitutes an emergency. Mali is the world's fourth poorest country, according to the United Nations, and Action Against Hunger has been supplying humanitarian assistance there since 1996, providing nutritional care and clean water. Each year, many Malians face a "hunger gap"—a span of months between the depletion of last year's harvest and the reaping of this year's crops. But in 2005, the hunger gap widened alarmingly.

Government officials responded with food distributions for humans and animals that moderated the situation. Action Against Hunger responded as well with emergency nutrition and food security programs targeted at the most vulnerable populations in the regions of Gao and Kidal. Our Supplemental Feeding Centers (SFCs) monitor nutritional conditions and dispense food to moderately malnourished children. Our Therapeutic Feeding Centers (TFCs) take in children suffering from severe acute malnutrition and restore them to health with medicine and a four-week dietary regimen.

When assessing malnutrition in a community, Action Against Hunger's teams calculate GAM through surveys, which chiefly involve two measures. The first is MUAC, or middle upper arm circumference, which gives a rough indication of acute malnutrition. The second is more precise and requires weighing children. According to this calculation, children are moderately malnourished when their weight-to-height ratios fall between 70% and 80% of an universally accepted median. Severe malnutrition is a weight-to-height ratio below 70% percent or the presence of leg edemas, which indicate a more severe form of malnutrition called Kwashiorkor. GAM is calculated by combining the level of moderate and severe malnutrition rates.

Today in Mali, Action Against Hunger is assisting more than 1,200 children younger than five who have moderate malnutrition, 950 lactating women—with a MUAC below 210 centimeters—who are nursing children younger than six months, as well as 550 pregnant mothers also with a MUAC less than 210 centimeters.

At our SFCs, every two weeks a needy family receives a ration that includes 66pounds of millet, a quart of cooking oil, and 11 pounds of premix (a combination of corn, minerals, oil, soy, sugar, and vitamins). While at the SFC, Action Against Hunger's nutrition teams also provide health education and nutritional training. Family members may also see a nurse or doctor if they have health problems.

Action Against Hunger's SFCs provide not only emergency relief but also education to show communities how to help themselves. "We're training the local hospital staff in nutritional surveillance and treatment, and we've established a Therapeutic Feeding Center within the hospital so they'll be able to monitor and address the situation in the future," says nutritionist Eva Vincent.

These efforts have reduced but not eliminated Mali's on-going nutritional crisis. "Overall," says Dr. Mashuka Marti, who oversees care at the TFCs and SFCs, "the program is successful, and we're seeing improvements in the mothers and children who come to the center every two weeks. One complication is that this is a nomadic population, so when the rain falls they follow their herds to pasture." In fact, rain has fallen since the most recent distribution, so the SFC has seen a drop-off in the number of mothers and children who have returned. "The emergency is now relatively stabilized," Dr. Marti adds, "but there's a need to develop specialized and long-term programs for pastoral populations that take into account their culture and customs."

Says Patricia Hoorelbeke, Action Against Hunger's Country Director for Mali and Niger: "We have 10 years of close cooperation with the Malian population, carrying out programs that support production, storage, and marketing of agricultural products; nutritional training for medical personnel; the construction of wells and cisterns; and training in health education. These experiences help us understand the context and what solutions are needed.

"Every year people die of severe poverty in Mali," says Ms. Hoorelbeke. "Schools are not good, health care, water and sanitation are poor, many people are chronically hungry eating only one meal per day. It's time for the international community to respond and to invest in long-term programs that can have an impact so future children in Mali don't have to know hunger as we see it today."

Adds Dr. Watltraud Novak, 31, an Action Against Hunger nutritionist in Mali: "If we can't carry out long-term programs that will reduce or ideally eliminate the hunger gap, people will continue to go hungry year after year. Action Against Hunger has started programs to show the pastoralists who follow their herds away from their villages in an annual routine how to create stores of food stocks in their home villages. That way, when the hunger gap hits, they'll have reserves to rely on. But these long-term programs don't have the donor support—neither institutional nor private—to make a major impact. We need a change of thinking to fund both emergency and longer term programs adequately so the people of Mali will have a chance to break out of the cycle of drought and poverty."