Kristen van Schie
Reporting from the Hawlwadag District in Mogadishu, Somalia
The Ilmow family sit quietly on the sodden couch. Jutting cheekbones. Sunken eyes.
They stare ahead vacantly, the resuscitation drips in their wasted arms having minimal effect.
Five-year-old Xaway trembles, her eyes half-closed. Too weak to lift the lollipop to her mouth. Too weak to shoo away the flies.
“Cholera,” says Dr Ismail Vawda. “The whole family. Fever, vomiting, severe diarrhoea.”
It has the same effect as rice water, says their father Madai.
His is one of thousands of rural families to escape the drought-stricken area south of Mogadishu, a trek of hundreds of kilometres.
They queue for hours outside the makeshift hospital, waiting for help. Waiting for food.
Tempers and temperatures rise under the summer sun.
Only a dozen families are allowed in at a time. They leave laden with maize meal, porridge, pilchards and infant feed.
Those mothers still waiting grow angry. They push forward. The guards whip back.
But they are hungry. So hungry, their bodies have started eating themselves.
First to go are the skeletal muscles and fat stores. Skinny legs, wasted arms. Biceps and triceps converted to sugar for the brain – just like the Ilmow family.
The body tries to adapt, slowing down the metabolic rate. But, still struggling, it wears away the vital organs. Liver, kidneys, lungs, slowly metabolised, slowly failing.
Running low on protein, the immune system fails. Infection sets in. Tuberculosis and cholera are rife. And children are most at risk.
“They grow a lot faster than their parents, so their energy requirements are a lot higher,” dietician Michelle Bristow explains. “And it’s in their weaning phase, those babies over six months old, where real malnutrition sets in. Breast milk is just not enough anymore.”
The hospital’s intensive care ward is filled with these children.
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