“It was the first time he got sick” – In a North Darfur refugee camp, one mother is grateful for the UNICEF-supported nutrition programme


Abu Shok, North Darfur, May 2015: Beneath the shade of a large canvas tent in a North Darfur refugee camp, several mothers lie on hospital beds with poorly, unsmiling children, hoping for a better tomorrow.


Some sleep with their toddlers under half-draped mosquito nets; others are awake and keeping vigil, waiting for their boys or girls to find strength.


On one of the ward’s steel beds, Kaltouma Mohamed Adam is sat with her 18-month-old boy Rami – a tiny child with wide, staring eyes and a glum expression.


Kaltouma arrived in the refugee camp about one month ago. She doesn’t know her age, but looks about 16-years-old. As she talks, Rami sits cross-legged on the bed next to her, clinging on to her left thigh as though he is worried he will fall off.


“I came to the clinic 14 days ago,” she said. “Rami had a cough and a runny nose, and this is why I decided to bring him.”


She and Rami are at the UNICEF-supported nutritional programme in Abu Shouk, a refugee camp which is home to more than 100,000 internally displaced people (IDPs) in North Darfur.


“Rami wasn’t able to eat,” said Kaltouma. “So he was taken to a medical assistant. She examined him with a stethoscope, and then said that he was such a bad case that he needed to be admitted to the ward.”


Implemented by the Kuwaiti Patients Helping Fund (KPHF), the programme is an example of the “integrated approach” to service provision which UNICEF believes can maximise results when it comes to child health and nutrition.


Integrating services

On the one hand, the centre at Abu Shouk offers a programme which mirrors the long-established approach of CMAM – the Community Management of Acute Malnutrition.


This is a multi-pronged initiative which utilises volunteer-led mobilisation and supplementary feeding programmes to tackle child malnutrition.


On the other hand, additional health and WASH services are also provided, such as vaccinations and hygiene instruction.


So when malnourished boys and girls are brought in for treatment, immunizers also check whether they are up to date with their polio jabs.


Or if they are queuing to have their weight monitored, mothers can at the same time receive WASH lessons on the importance of children using hygienic latrines.


It means that UNICEF-supported staff are able to maximise the chances of improving the welfare of children in the camp.


“If you don’t have integration it means there will be more complications for the children,” said Ahmed Mohamed Abdel-Hamid, medical co-ordinator for KPHF.


When mothers are with their children in the ward, said Mr Abdel-Hamid, then the nurses will also take time to show them how to wash or give them breast-feeding advice.


“In addition,” he said, “if a child has a bed sore then the nurses will be able to treat it with a dressing. Or if they have an unexplained fever, then we can send them to the laboratory here and see if we can diagnose it.”


Vaccinators are also on hand to check whether children are up to date with their immunizations, he added – a particularly important service for malnourished children, who are at greater risk of complications if they contract dangerous diseases such as measles or polio.


The perils of tradition

In the case of young Rami, he became malnourished partly as a result of his mother falling prey to one of the biggest bugbears of nutritional workers in Sudan – the influence of “traditional” medicine.


Kaltouma recently became pregnant for the second time, and consequently she stopped breast-feeding. She believed, like many mothers in Sudan, that breastmilk becomes bad once women become pregnant, and should not be used to feed young children.


Rami soon fell ill, and later entered the CMAM programme at Abu Shouk.


Like all CMAM initiatives, the Abu Shouk programme operates using four key components – all designed to enable the community to help tackle child malnutrition for themselves.


Firstly, there is community mobilisation, where volunteers are encouraged to reach out to families in the camp and try to identify boys and girls who might benefit from the service.


Then there are the two nutritional programmes themselves – the Supplementary Feeding Programme (SFP) and Outpatient Therapeutic Programme (OTP).


In the first instance, the SFP provides food rations for children who are only moderately malnourished. For more severe cases, OTP offers home-based treatment for boys and girls – though only if they are suffering no additional maladies as a result of their malnutrition.


Lastly, for the minority of cases who require it, CMAM provides Inpatient Care for the most severely malnourished children who have also developed medical complications.


Rami fell into the final category, and was admitted to the stabilisation centre ward at the KPHF nutrition programme. Initially he was fed on formula milk. Like other children on the ward, he was also weighed every day and assessed by the medical assistant.


After a successful “appetite test” – where health workers see whether new children want to eat food – he started eating “Plumpy Nut”, a supplementary food given to malnourished children. He gained weight, and his prospects are now looking much better.


“It was the first time he ever got sick,” said Kalthouma. “But I’m very happy now that his health is now improving.”