Dakar/Nouakchott — In Mbéra refugee camp in eastern Mauritania, home to 55,000 Malians, just under one child in five is malnourished, and 4.6 percent are severely malnourished - two to three times the national average, according to a just-released November survey by NGO Médecins sans Frontières (MSF).
Children under five are dying mainly from a combination of malnutrition and malaria, respiratory infections and diarrhoea, according to MSF head in Mauritania Karl Nawezi, who describes the situation as "alarming and unacceptable".
Only 70 percent of under-fives have been vaccinated against measles, causing concern about further deaths as the combination of measles and malnutrition is usually fatal. MSF is calling for an emergency measles vaccination campaign to bring coverage up to 95 percent.
Mortality rates are high partly because mothers do not bring their children to health centres in the camp until they are almost dead, Nawezi told IRIN last month in the capital Nouakchott.
Just under half of mothers abandon the therapeutic feeding programme designed to bring their acutely malnourished children back to health partly because as nomads, they are often on the move, travelling within Mauritania and to and from Mali.
Need to rethink food aid?
Malnutrition rates are also high partly because refugees have had to adapt to a completely different diet, dominated by cereals instead of the milk and meat they are used to.
Many families sell a portion of their food rations to procure a small amount of milk or meat for their children, according to MSF.
The situation could get worse if assistance to refugees does not improve, said Nawezi in a 9 January communiqué.
"To avoid high death rates among severely malnourished children we need to rethink food aid," he said, suggesting that income-generating activities and distribution of goats to nomads would be useful, given most refugees are likely to stay over the long-term, given pending military intervention in the north.
Alain Cordeil, head of the World Food Programme (WFP) in Mauritania, said according to post-distribution monitoring studies, just 10 percent of distributed cereals were sold - partly to buy milk, meat and tea, partly to pay for wood, transportation or other costs. One in four refugees they asked, said they wanted milk and meat. "So 75 percent have not indicated this," he told IRIN.
One reason cereals are being sold in the markets is because the UN Refugee Agency (UNHCR) originally estimated the number of refugees to be 80,000-100,000 as opposed to the 55,000 recently tallied, creating a surplus of cereals, he said.
But several aid agencies and two Malian refugee groups in the capital Nouakchott told IRIN refugees had problems with the food they were receiving. "The most persistent problem we hear of in M'béra is the food problem - we are a nomadic people and we live on milk and meat," said Zakiatou Oualette Halatine, spokesperson for the Nouakchott-based Association for Refugees and Victims of Azawad.
WFP is nonetheless looking into replacing one of the foods they currently distribute with cash vouchers, which would enable refugees to buy what they want, but they need to sufficiently study the market first, said Cordeil.
Malians are continuing to arrive in Mauritania as news of impending military intervention evolves. On 9 January the Malian army reportedly quelled attacks by Islamist groups in Konna, 70km north of Mopti in central Mali.
"Evidence of real despair"
Some Mbéra camp residents have said they are ready to return to the Islamist-held north, despite the imposition of strict Sharia law, to tend to the herds they left behind, and to return to more familiar cultural practices, including foods they know. "This is evidence of real despair," Nawezi said in the communiqué.
Malnutrition rates among northern Malians were traditionally much lower than in the rest of Mali because of the protein-rich animal and milk-dominated diet, according to NGO Doctors of the World.
MSF manages two health posts and a healthcare centre in Mbéra camp, and two additional health posts in Fassala and Bassikounou, not far from the camp. The NGO is setting up an emergency obstetrics unit so that women with pregnancy-related complications do not have to travel 200km to Néma to seek help.
Nutrition is increasingly part of the Mauritanian government's development plan, according to the UN Childern's Fund, UNICEF, in Nouakchott.
But government health posts have very little capacity to address malnutrition in many rural areas, including most of eastern Mauritania, say aid agencies.
MSF is building up its health teams in Mbéra and is considering doing house-to-house visits to try to ensure children are not suffering behind closed doors, said Nawezi.
According to the July 2012 nutrition "SMART" survey, 1.8 percent of children assessed in Mauritania are severely malnourished, and 12 percent malnourished.
[This report does not necessarily reflect the views of the United Nations.]