Malnutrition will leave youths with lasting scars Brain functions, growth are stunted OPERATION RESTORE HOPE

December 10, 1992|By Fort Lauderdale Sun-Sentinel

The photos of tiny children, with bellies swollen and arms an legs pathetically thin, show the misery of Somalia. What they can't show is that many, even with emergency help, will be forever scarred by the famine that grips their country.

Aid workers say 300,000 people have died so far; the total could reach 500,000 by the end of the year.

Relief agencies are feeding 3.2 million people a day, but a third of the population of 6 million remains threatened by starvation. And the youngest generation -- children under 5 -- could be wiped out in some places.

The food in Mogadishu warehouses will save many, once supply lines are opened and secured. But in a country without a government, ravaged by gangs of gunmen and torn apart by a half-dozen warring clans, that job will be enormous.

Still, relief agencies have managed to open more than 1,000 feeding centers in Somalia. In some areas, conditions have improved greatly since the famine started more than six months ago.

But in others, hundreds of thousands of people wait, praying for food.

They suffer from "kwashiorkor" -- severe protein malnutrition. For adults, the toll is terrible; for children it's even worse. It stunts their growth, destroys muscle mass and, in infants, hampers development of the brain.

"When this occurs in infancy, which is the most critical period, brain growth and development are affected," said Lucille Beseler, a pediatric nutritionist in Margate, Fla. "Studies show that intellectual development might be impaired and it might not be reversible."

In older children, the problems probably will be temporary. With proper nutrition later, they can probably catch up, she said. The big problem now is making sure they live that long.

"They have absolutely no fat stores anymore; they have muscle breakdown. They look as if their muscles are really wasted -- the pot-belly look is part of that," she said. "I'd say they are in very bad shape."

The worst off suffer from withered intestines and can only be fed intravenously. In a hospital intensive care unit, many would survive. But there are no such facilities in Somalia, and there are thousands who need that kind of care.

Malnutrition is so widespread that doctors such as Dr. Gwen Wurm, director of community-based pediatrics at the University of Miami, worry about widespread outbreaks of potentially fatal diseases, from diarrhea to tuberculosis to measles.

"Nutrition is what keeps us healthy, keeps us at the baseline," she said. "When you are malnourished, you don't have the tools to fight infection."

Deficiencies of things such as vitamin A, niacin, iron and vitamin C can quickly lead to diseases like anemia or scurvy, Dr. Wurm said.

Even fairly minor diseases that cause diarrhea can be fatal in people who are badly dehydrated. Diarrhea was blamed for 28 percent to 40 percent of the deaths in famine-plagued refugee camps in Somalia in 1980 and Ethiopia in 1989, she said.

The agencies providing emergency food supplies have to be extremely careful because too much food at one time can be deadly. Concern, an Irish relief group, feeds adults and children eight times a day, giving them tiny portions of a porridge of beans, wheat and cooking oil.

And CARE, which is distributing much of the food for Somalia, will give children a mixture of sorghum and wheat that will be easy to digest but will provide the protein and other nutrients they desperately need.

"For those kids on the brink, we're turning it into a porridge, something they'll get maybe three times a day," said Hope Rosenberg, a communications officer with CARE in New York. jTC "It's not like having an egg or something, but it is fortified."

Some children, too weak even to eat that, will need to be rehydrated with a glucose solution that gives them liquid and some nutrition, Ms. Beseler said.

Ms. Rosenberg said that because of the famine, some Somalian children will always be smaller than they should be, and some will be intellectually impaired.

"But many of these kids, after a few weeks, will start to laugh again and play and act like normal kids," she said.

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