Emaciated baby Jibril is lucky. If he hadn’t been carried by his mother from their village in eastern Mali, to the main hospital in Gao on Wednesday morning, doctors say he would have been dead by Thursday.
Jibril’s mother coddles the limp child in her lap as nurses bustle about mixing life saving formulas and recording vital statistics - height, weight and age - that will be monitored over the four weeks they expect it will take for him to recover.
The doctors estimate Jibril must be about a year old, but he weighs in at only 4.3 kilos. His target weight before he can leave the ward is 6.2 kilos.
Within an hour of arriving at the hospital Jibril’s been cajoled into drinking a plastic cup full of rehydration formula teaspoon by teaspoon, and is accepting some specially enriched milk, the first real food he has had in days.
"This is a typical case of severe malnutrition, if he was any worse than this, he would be dead," said Clara Marti Mashooka, the paediatrician for French NGO Action Contre la Faime working at Gao main hospital.
According to government figures 1.1 million Malians are short of food this year after a severe drought and a plague of locusts ravaged crops and animal herds.
Children are the hardest hit, particularly those between six months and five years, who are no longer breast feeding and prone to malnutrition as they don’t get the protein and vitamins they need from their meagre diet, explained Mashooka.
Jibril is so wiped out with hunger that his body is limp and even focusing his huge eyes on his mother takes too much effort. He has the face of a wizened old man. His skin hangs from his tiny frame in folds. It can be pinched and twisted on his belly where it stays in a tight knot.
"When it doesn’t spring back like that, it’s a sign of severe dehydration," explained Mashooka.
But within an hour, his skin is already regaining some of its elasticity.
Recovering muscle tissue that will enable Jibril to sit up, will take a few more days of intense care and food every three hours.
After about a week, Jibril should be able to stand with help and have enough energy to take an interest in things around him that includes reaching for offered milk rather than being teased and coaxed into accepting it.
"It’s very satisfying seeing the rapid progress that the children can make," said Mashooka, "but it requires intensive care."
Jibril’s mother, Sidi Boukoum Adama, set out for the hospital on foot from her village of Tondibi, some 50 km north of Gao on Tuesday morning. She walked through the heat of the day, and took a boat over the Niger River resting the night at a relative’s house in town before going to the hospital.
"My husband told me to bring him to the hospital when he refused food," said Sidi. She and her husband are from the Songhai ethnic group. They are sedentary rice farmers.
But this year’s rice stocks were decimated by last year’s locust swarms, and though the rains are falling, the new harvest has not yet been reaped and bellies are growling with hunger.
Sidi doesn’t know her age but the nurse guesses she is in her twenties. She has had four other children, though one of them died last year. It is not clear whether that too was due to malnutrition.
It’s also not clear whether Sidi has made the association between her child’s condition and his diet.
"It’s an illness of God," Sidi tells the nurse, who translates into French.
Most of the children that arrive at the hospital will recover. But of the 60 or so that have been treated so far, three have died.
One child died on Friday. "We got her too late," explained Mashooka. The two-year old had wasted away to only five kilos.
Yet the child was not brought in from some remote village, but had lived in Gao town within a short walk of the hospital and the shady maze of Gao market where oranges, yams, rice, fish and meat and much more are all on sale.
Of the 17 severely malnourished children in the pediatric ward on Wednesday afternoon, eight or nearly half of them, live in Gao town.
"Word is getting out that the treatment is free, so now more mothers are coming," said Mashooka. But that doesn’t solve the problem that there are people in town too poor to buy the food they can see on the market.
Touwa Walett Eglas is one such mother. She’s at the hospital for the first time with her youngest child, Hamamata, who’s severely malnourished. She’s had six children in all, but three of them died. She didn’t take them to hospital.
"Hospitals are always so expensive," said Touwa. She is a black Touareg, one of the poorest and most marginalised groups in Mali. Traditionally they are a slave cast, indentured to lighter skinned Touareg families that roam the desert with their animals.
But Touwa, her husband and two surviving children abandoned their nomadic lifestyle last year, after the last of their herd of a dozen goats died. The locusts swarms that ravaged West Africa in 2004, stripped all vegetation leaving nothing for their herd to eat.
"There was nothing there for us, so we came here for a better life," said Touwa who has transported her thatch and weave nomad tent to Gao's downtown district of Chateau.
"But the problem is my husband only knows how to live in the bush, he doesn’t know the ways of the city." He can’t find steady work and she never knows where the family’s next meal is coming from never mind money to pay hospital bills.
However, after her positive and free experience at the hospital, Touwa says she would come again if any of her children fall ill, but not before visiting her traditional healer, or marabout.
"If you get good traditional medicines, they are very good and better than the hospital," she said.