**MALNOURISHED CHILDREN**
The U.N.’s World Food Program, a major food aid distributor that plays a vital role in Afghanistan, says a lack of funding means it will reach just over six million hungry people this winter with emergency food aid — less than half of those who need it.
Among children, malnutrition is on the rise. An estimated 2.9 million Afghan children will suffer acute malnutrition in 2024, according to the Humanitarian Response Plan for this year. Another 570,000 children are expected to become malnourished next year, according to Harald Mannhardt, the WFP’s deputy country director for Afghanistan.
Doctors at remote clinics run by international nonprofit are among the first to catch the most desperate cases.
Just a few minutes outside Herat city, crowded markets and leafy boulevards give way to vast skies and sand-coloured dwellings that look as though they’re carved into the arid landscape. Goats and sheep roam over desert terrain that resembles the rocky surface of Mars.
About two hours drive along the wide asphalt road that connects Herat to the Turkmenistan border is a health clinic called Yaka Dokan. It’s run by World Vision, a nonprofit active in Afghanistan for over two decades. The clinic, housed in several adjoining white shipping containers, serves 16 villages with a combined population of 5,400 people. It sees up to 150 patients a day, mostly children.
One weekday in October, more than an hour before the Yaka Dokan clinic is scheduled to open, a dozen women in billowing black burkas wait outside the gates. They huddle against the white wall circling the clinic, trying to shield their children from the bitter wind. By the time World Vision doctors drive up to the clinic in their minivan, more than 20 women and a dozen of their male guardians are assembled outside.
A few minutes after the clinic opens, dozens of women with babies and toddlers are queued up outside the office of Gulnisa, a 28-year-old doctor who serves as a community nutrition promoter for World Vision. Gulnisa and the other doctors interviewed for this story asked that only their first names be used, in line with the media policies of their organisations.
Wearing a white coat and a tartan scarf to cover her hair, she begins pulling out worn notebooks. A mother cradles a nine-month-old baby while another child sits quietly beside her.
Gulnisa instructs the mother to roll up the baby’s sleeves so she can use a colour-coded tape to measure the boy’s upper arm. The baby begins to wail loudly as the doctor helps the mother lay him on a small scale. A wooden measuring device is then used to check his height. Once the boy is back in the mother’s arms, Gulnisa carefully touches his feet to see if there is any swelling visible on his limbs, an indicator of acute malnutrition. The doctor checks the measurements against a chart, which helps her determine whether the boy is malnourished.
The baby is too small for his age and is on the cusp of moderate malnutrition, Gulnisa tells the mother.
“He cries day and night and doesn’t sleep,” the mother says as she tries to hold the wiggling child in her arms. They have travelled from a village several hours away.
“Auntie, come sit down,” Gulnisa says, waving at a grey plastic chair. “Is he breastfeeding?”
“I give him goat’s milk,” the mother says in a tired voice.
“Why not breast milk?” Gulnisa asks. Informational posters about basic hygiene and the myriad benefits of breastfeeding cover the doctor’s walls.
“How can I? I have no milk at all,” the mother replies.
The doctor hands the mother a plastic bag with 15 sachets of therapeutic food supplements. Leaning over her desk, she demonstrates how to knead the small red and white sachet before cutting it open to squeeze out the supplement.
“Before giving him the food, you need to wash your hands with soap. Not only your own hands, but you must also wash your child's hands,” Gulnisa says, explaining in detail how to also try to feed the boy soft foods like porridge.
“You must also collect the packaging and bring it with you when you come back. Every 15 days, which is two weeks later, you should come here on a Wednesday,” she says. “What day should you come? How many days later?”
“After 15 days,” the mother repeats after her.
“You must give the food only to this child and no-one else, understand? Who should you give the food to, Auntie?”
“This child,” the mother replies.
If doctors were to screen an average of about 50 patients in a day, they’d find 20, sometimes 25 cases of moderate malnutrition, says Nisar Ahmad, another doctor at the clinic. An additional 10 patients or less would have severe malnutrition. Of those most severe cases, three or four of the children will have complications caused by a lowered immune system that need to be referred to a larger hospital.
“The situation is moving towards a crisis,” says Nisar Ahmad, 31.
Both doctors worry about what the winter will bring. Gulnisa spent last winter working in an even more remote clinic several hours northeast of Herat city. She says many families in far-lying villages there only had dry bread or potatoes to eat.
“In the villages where we work, things have got worse,” Gulnisa says.
Since the Taliban returned to power, the number of sites treating malnutrition has quadrupled, health ministry spokesperson Sharafat Zaman told Reuters. “We are fully prepared for this winter,” he said.