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Did you notice a lot of malnutrition? If so, was this a major cause of death or did it rather exacerbate the morbidity and mortality arising from other conditions?
Yes, we saw a lot of malnutrition. There were about one hundred kids in the center at any given time, approximately 85% of which suffered from severe malnutrition. There were about thirty admissions per week. We were sure that we should have been seeing more children than that. With a population as large as 80,000 IDPs and 100,000 residents, to have only one hundred kids with severe malnutrition in a pediatric center is just ridiculous. Though we tried to make ourselves accessible, we really felt that we needed to have more of a presence in the camp in order to catch all of the severe cases of malnutrition. Such an effort was beginning as I left. Whether malnutrition was a major killer or a contributor to other conditions is an issue of semantics to me. Some people say that malnutrition does not kill; instead, it sets them up for other diseases. To me, what’s the difference? It’s all the same. Certainly, someone does not die specifically because they are malnourished, but they would not have developed such severe diarrhea or anemia if they were not malnourished to begin with. In my eyes, yes, malnutrition was the killer. A good analogy would be with HIV. AIDS patients die because of the opportunistic diseases that they acquire, usually not because of the virus itself.
How do you define malnutrition and what are the different classifications comprising this condition?
Malnutrition is a serious condition that can impair physical growth, and that can lead to behavioral changes, developmental delays, permanent cognitive defects, and a weakened immune system. Malnutrition is basically an imbalance between your body’s supply of nutrients and energy and its demand for them. There are two main classifications of protein-energy malnutrition [PEM]: kwashiorkor and marasmus. Kwashiorkor occurs when the body suffers from low protein intake, but enjoys adequate total calorie intake. The condition is characterized by edema (swelling), skin and hair changes, and irritability. Marasmus, in contrast, results from a deficient intake of both protein and total calories; edema is absent in this condition. Malnutrition can be either ‘acute’ or ‘chronic.’ Acute malnutrition is characterized by a low weight to height ratio and can cause immediate complications such as dehydration and anemia, which may in turn lead to cardiac failure or hypothermia. Chronic malnutrition, on the other hand, is characterized by low height for age, or stunted growth. Whereas weight change can occur quickly as a result of acute malnutrition, it requires years of chronic malnutrition for someone’s height to be affected. Chronic malnutrition does not necessarily set children up for the same immediate complications that occur with acute malnutrition; it takes its toll on the body in other ways. There certainly can be acute malnutrition superimposed on chronic malnutrition, which I suspect was happening in Darfur. We saw many kids with severe acute malnutrition. They might have previously had chronic malnutrition from a lower than normal intake while living in their villages. However, in the new IDP camp setting, their food supply was basically cut off, leading to severe acute malnutrition.