Niger in a time of crisis is not a place for the faint of heart.
I felt this most profoundly one day last June when I found myself handing over sacks of rice, lentils and salt to dozens of mothers in the 2,000-person town of Rwafi. Across from me, in this small cement health post on the southwestern edge of the Sahara Desert, hundreds of eyes met mine. These eyes betrayed the indomitable fortitude and resiliency I have come to expect from women in rural Africa. Yet they also revealed their deepest needs, as each one hoped I would provide them with sacks of rice, lentils and salt, too.
My job on this 110-degree day in the desert, the second of my three-day trip to the Filingué region, was to help Mercy Corps' nutrition team distribute rations to 230 families — a small part of our efforts to ease the persistent food crisis and to bolster the capacity of the country's public health system to detect and treat child malnutrition.
Across this land, hundreds of thousands of children who have survived seasons of drought today simply do not have enough food to eat. Since last summer, Mercy Corps has been helping health centers identify and treat malnourished children, distributing food supplements, providing basic medical treatment and strengthening community health committees. In Rwafi and neighboring villages, 2,404 children under five have been admitted since the program's start.
Hard times in a harsh land
Few people inhabit this landscape of sand and scrub brush. We passed only a handful of settlements during the three-hour trip from the town of Filingué, a provincial outpost northeast of the nation's capital, Niamey. A lone truck that plies the road between Filingué and Rwafi is the only form of public transportation available. When we passed it on the way, the truck was so overstuffed with people that some passengers rode atop its front hood.
Rwafi's residents live in a cluster of adobe homes surrounded by fields of millet. Millet is Niger's staple grain, and also fodder for goats and cattle. Livestock is both food and currency here. The health center is the only cement building in town; it has an office, storeroom, a room in which babies were weighed and measured, a waiting area and a couple of beds for inpatients.
Inside, I met Zada Hamidou, the nurse. He's the only trained clinician, as well as the senior administrator, for three health centers that cover about 20,000 people who live within 50 kilometers in any direction. Zada told me Mercy Corps' decision to support local clinics' malnutrition treatment programs helped draw residents to the health centers for other important medical needs — vaccinations, nutrition advice, family planning information and so on.
After a night spent under the stars on a mosquito-net-covered mattress, my colleague Dare and I awoke to a situation that brought home how precarious life is out here. A woman and her husband arrived in a donkey cart. They had traveled 13 kilometers after she had given birth to one twin. Staff carried her, barely alive, into health center before she gave birth to the second child.
"Oftentimes, people will wait too long in their villages in childbirth before they seek help," Zada lamented to me later. "These are some of the most difficult situations we face, these women who've not been brought in soon enough."
Checking off names for food
Later that day, I checked off the names of the families as they came for their sack of grain. It's the first time in the 14 years I've worked in a variety of international-development roles, mostly in southern and central Africa, that I've seen such malnutrition and need.
Eligibility in the health centers' child nutrition program is determined by a weight and height standard used by the UN. Qualifying families receive a blue card and their name is put in a ledger. They receive a monthly supply of a soy-based nutritional supplement for children under the age of five. Children who reach desired weight through the assistance and monitoring of health center staff "graduate" from the program.
For this day's distribution, Mercy Corps had sent an advance team to Rwafi to explain the eligibility rules and the process to the health center staff, village chiefs and local health committees. But people here are desperate, so dozens of people not enrolled in our program took a chance and came in.
I saw children in the malnutrition program with sunken eyes, skeletal bodies and arms as thin as a roll of dimes. I saw some teenage girls carrying sickly children on their back. And I faced dozens of incredibly strong and determined women who looked at me plaintively in hopes that I would issue them a sack of grain. As a colleague noted, these are the kind of heart-wrenching situations the health center professionals face every day.
It is easy to see these women as victims — of nature's whims, of political failures, of their unlucky lot in life. To me, however, these women are survivors: strong, capable and determined people who work incredibly hard to provide enough for their families. Their husbands seek work in larger cities only because there are few wages to be earned here. But today, because times are so desperate, even the most resourceful among these families are forced to seek assistance.
Capacity is strengthened, but needs persist
Niger's food crisis shows few signs of subsiding in the area north of Filingué. The rains were already a month late. Beyond the expanse of fields, I saw no gardens or fruit trees to sustain these families. Residents here must purchase their food, either by selling off livestock or extra millet, or by going into debt with local traders. Livestock are increasingly scarce, and the community's three millet storehouses are empty.
"People don't have money to diversify their diet," Zada told me. "Many families are relying on one meal of millet porridge a day." In fact, there are already reports further north of animals dying and migrant workers, usually self-reliant, seeking food aid.
But there is, thanks in part to Mercy Corps, a better early-warning system and stronger capacity to respond. Data from Rwafi's health center flows into a growing national database intended to help the government identify and respond to areas where food is running short. Village health committees are starting to fill their role of getting word out about what the health center offers. And Zada reports that he's more regularly visiting the two other health centers under his direction, thanks to Mercy Corps funds to repair and fuel his motorcycle.
But the demands remain overwhelming. In Niger, many people are busy with the simple yet arduous task of survival.