In El Wak, Kenya, the land might find relief, but malnutrition has taken hold

Katra, nine months old, whimpered and weakly kicked as MSF staff tried veins in her arm, head, foot, anywhere on her tiny shrivelled body to place an IV drip. In the end they had no choice but to encourage the mother to feed her orally and gave her antibiotics for the respiratory infection. Sadly, after four days of suffering from diarrhoea and vomiting, she faded away, her eyes sunken and hollow.

In April, MSF communication officer Lucy Clayton visited El Wak in northern Kenya, where MSF is running a nutrition programme.

There is an uneasy sensation of lives hanging in the balance in drought stricken north-eastern Kenya. On the one hand, land that had been without water for months is now rapidly sprouting green shoots - the result of several heavy downpours during the last couple of weeks. Regular patches of leafy scrub now dot the flat red earth and donkeys and goats nibble on the thin new grass.

On the other hand, the future is looking extremely uncertain. Although the skies often darken in the late afternoon as the air thickens with the promise of a storm, it is currently a tense waiting game. Perhaps there will be more rains, flooding the paths in minutes, turning the dust into sludge, making the roads impassable, but ultimately watering the pastures on which local people are so utterly reliant. Perhaps the skies will stay dry and the annual "long rainy season", which supposedly lasts from April to June, is already over.

Whether or not more rains fall, the vast majority of people in this area already find themselves in a gruelling predicament. Almost three quarters of the population are pastoralists: nomadic people who depend on their cattle for everything - sustenance, livelihood and social status. Things are calculated in cows around here: two cows to put your kid through school for a year, 50 cows for your new bride, three cows to be paid to the poor as an annual tax.

Yet in the last six months, a huge proportion of the livestock in the area has died for lack of water. The outskirts of towns are littered with the bodies of camels, goats, cows and donkeys in various stages of decay. Their carcasses are being burned and, for pastoralist people, it is like watching their life savings go up in smoke. It takes many years to rebuild animal herds. Now even a solid month of rain will not help them do so anytime in the near future.

People are now struggling, both literally and figuratively, between a rock and a hard place. They have to try and ensure food security for the future by keeping their remaining animal stocks alive. That means staying in the bush with the herds in search of pasture, going wherever there is something for the animals to eat. At the same time, they need food and water to feed their families right now. Previously, they drank milk from their camels, goats and cows, ate meat from their stocks or the market and had rice, maize and some fruits. Now milk and meat is scarce and the goats are too thin to trade.

A nutritional assessment carried out by MSF three weeks ago around El Wak found that 30% of children under five are moderately or severely malnourished. Considering that a percentage higher than 15% is normally taken to indicate an emergency situation, this is very serious. The organisation has now admitted almost 300 children into its mobile feeding programme, 30 of them over the past week.

Running a nutritional programme within the context of a pastoralist society is quite a challenge, and normal protocols have had to be adapted to suit a population that moves from place to place. A typical feeding programme would involve mothers bringing their children to a fixed point and staying with them whilst they are treated - sometimes for as long as a month. However, for families desperate to find pasture for their surviving animals, this is not at all easy, especially if there are other children to be cared for too.

That is why MSF decided in this case to run an 'ambulatory' programme, with a small team visiting five different locations once a week to weigh and measure children, check their progress, treat infections and distribute a week's supply of a highly nutritious peanut paste called "Plumpy Nut" until they return the next week. Only children with medical complications and those who fail to gain any weight over several weeks are referred to a therapeutic feeding centre (TFC) in El Wak town for intensive 24 hour care.

Children who fit these criteria are now on the rise and there are currently 13 babies being cared for. The first two deaths occurred last week. One was nine month old Katra who arrived at the centre ten days ago from a town about 12 kilometres away. She was severely malnourished and had a respiratory infection. The team struggled desperately to find a vein for an IV drip to rehydrate her, but it was impossible. She whimpered and weakly kicked as they tried veins in her arm, head, foot, anywhere on her tiny shrivelled body.


For the MSF team, the fear is that there will be more cases like Katra because of the lack of clean water supply. There have been mechanical problems with the borehole pumps in at least two of the surrounding towns, and people have started using water collected from small ponds and roadside puddles instead. At one pond, a local man explained that the land had been dry before the recent rains and had been full of livestock carcasses. When the first rains came two weeks ago, the carcasses became submerged and, although the locals pulled some of them out, some could not be removed.

Now, because the borehole pump is sometimes broken and people have to pay for water even when it is working, local residents are using the pond water to wash and cook with. The local health authorities have no equipment to test whether the water is contaminated, but recently there have been several reports of people suffering from vomited and diarrhoea in the area. MSF took stool samples from patients for laboratory analysis, but they have to be flown to Nairobi on a plane that only leaves twice a week. It will take some time. MSF is now trucking water around the area to try and provide at least 10 litres of clean water per person per day.

In the meantime, the small MSF team of nine Kenyans, a Swedish nurse and a French project coordinator are working a hectic seven day week, and the supplies of Plumpy Nut are diminishing rapidly. Their movements around the area carrying the lifesaving fortified food are becoming familiar to local people: as the MSF car negotiates the bumpy roads between towns, pastoralist families emerge suddenly by the roadside to stop them.

Two children from one nomadic family have been accepted into the nutrition programme and, when the MSF car passes, their mother rushes out from the bush, franticly waving a silver streamer made of used Plumpy Nut packets behind her to attract the drivers attention. The children are weighed and measured by the MSF nurse at the roadside, their progress is recorded and the next week's ration of Plumpy Nut handed out. Then the family turns and disappears back into the scrub, their brilliantly coloured dresses billowing out behind them.