A malnourished girl in southern Ethiopia (1): Sheleme's Story

They're sitting side by side on one of the blue mattresses in the MSF stabilisation centre in Kuyera in the Oromiya region. Sheleme and Kutuba are twin sisters. Their tiny four-year-old frames are dressed in identical flower-print dresses. The twins were admitted to the centre today because they're both suffering from severe malnutrition and urgently need to be hospitalized.

Karen, the MSF doctor, examines the little girls and something jumps out at her right away: Sheleme, who is staring up at her with mournful eyes, is suffering from oedema. As a result, her legs, feet and face are bloated and swollen. She's reached the "kwashiorkor" stage, which is evident by the swelling under her skin and indicates a severe stage of malnutrition. Kutuba isn’t suffering from these complications and she seems to be in a less serious state. All the same Sheleme also has a sad, lost, look on her face that is typical of severely malnourished children.

Their mother Subo explains that this year, life has simply become too difficult. "The rains have stopped and the corn and beans didn't grow well. The cows didn't give any milk." It's become impossible for she and her farmer husband to feed their four girls and one boy.

It's a few minutes after 4pm. At 6pm it will be time for the girls to take their first ration of F75. It consists of the lightest therapeutic milk that is given to children in "phase 1" of treatment.

Sheleme will have to find her appetite now. She will have to rid herself of the oedemas that are disfiguring her face and causing her pain. The process will have to be taken little by little, step by step.