(This story was originally published November 23, 2008.)
PORT-AU-PRINCE -- With arms and legs so skinny they look like twigs, 2-year-old Davidson Pierre has to struggle just to sit. So he remains sprawled on his back and stares listlessly at the ceiling. He doesn't smile. He doesn't cry.
For eight days now, the boy has been on a high caloric diet of enriched milk and doctors say his fragile body is responding.
Davidson, like the others at the makeshift Martissant children's malnutrition clinic run by Doctors Without Borders, shows all of the telltale signs of extreme malnourishment -- stunted growth, brittle orange hair, skinny arms and legs and bloated bellies.
"When we found them, they were nearly ready to die, " Max Cosci, the head of a Belgian contingent of Doctors Without Borders, said surveying the room of acutely malnourished children and their worried mothers. "Now they are doing much better."
With UNICEF estimating that 300,000 children were affected by the string of storms that battered Haiti this summer, destroying crops and livestock at a time of already high food prices, international relief workers are worried that already vulnerable Haitian children are even more at risk of dying.
The concerns come as aid workers finally gain access to sparsely populated hilly villages in regions like Baie d'Orange in southeast Haiti, where 26 children died in the last month, reportedly due to severe malnutrition.
Fednel Zidor, government delegate for the southeast region of Haiti, said Saturday that 46 children were hospitalized in recent weeks for severe cases of malnutrition from the Baie d'Orange area. Others are being treated at home.
"Forty-five to 50 percent of the population in the Baie d'Orange region is being affected, " he said. "We can say we have a famine situation in that region."
Nobody knows if the problem is more widespread than that.
SCALE OF PROBLEM
Doctors Without Borders, an independent humanitarian group based in France, is in the middle of an assessment of Haiti's southeast region that started three weeks ago, and UNICEF only recently completed a survey of the Northwest region.
"We still don't have a proper picture of what's going on, " said Isabelle Mouniaman Nara, who heads a Doctors Without Borders mission in Port-au-Prince. "Some of the nongovernmental organizations did rough assessments . . . and came up with high numbers."
The first Doctors Without Borders team arrived in Baie d'Orange about three weeks ago. Initially, doctors struggled to find patients in the mountainous region, accessible only by donkey or on foot, and more than two hours outside of the town of Jacmel.
Now they are being flooded with them, Cosci says, after airlifting 20 children and their mothers to hospitals in the capital for emergency treatment.
Shortly after arriving at the Martissant clinic, two children died, said Dr. James Pallett who has been treating the kids. Pallett said all of the children being treated share a common trait: they are malnourished -- not because of starvation, but from not eating enough protein.
Haiti's poor rely heavily on starchy foods like rice and plantains because protein-rich foods like meat are too expensive.
Cosci says that while doctors are still searching for answers, he believes one of the problems is the way in which villagers cultivate the land. "They are just cutting the trees [and] planting on the mountain, and it is not good for the soil, " Cosci said.
"In some villages you have carrots the size of my finger and [six miles] further, you have carrots that are like in the markets in Europe, " he said. "They are planting, but [the soil] is not good for them to cultivate there."
But while that could be a contributing factor, parents say the summer storms definitely added to their misery by destroying crops and the few farm animals families depended on for a living. High food prices already had sparked deadly riots in April.
"It didn't leave us with anything, " said Jeannette Tatta, a mother of seven who brought her 2-year-old baby Jean-Edy to receive help. "I had a farm. It destroyed everything. I had animals. It washed them away. It carried everything and left us here to suffer with children dying in our arms."
The food shortages caused by the storms, she added, also spiked food prices and left mothers like herself unable to afford even a plate of beans and rice.
Tatta's worried face and the emaciated look of her child are stark evidence of the depth of the crisis.
In recent days, the more fortunate victims have ended up in hospitals and are receiving round-the-clock care. Others, like 8-year-old Berlinda, are left to suffer without medical care in makeshift orphanages.
On a recent Sunday in the town of Cabaret, as the hungry cries of 124 other orphans echoed through a nightclub with no windows, no doors and only a leaky thatched roof, she reclined on one of only three beds inside the vast space. Too weak to lift her body, she complained of an aching throat, but the sores covering her face and emaciated frame drew attention.
With no access to potable water, she and the others have been drinking the polluted water from a nearby river where weeks earlier dead victims of Hurricane Ike floated. Instead of a balanced meal, breakfast consisted of bread and dinner was rice with beans. No meat.
"They are malnourished, " said Lucienne Phillipe, 42, director of the orphanage.
Myrta Kaulard, country director for the U.N. Nations World Food Program, said the food aid organization is really concerned about the crisis that may be brewing, especially in hard-to-reach pockets of the country. Last weekend, she visited Cazale, another mountain village just north of Port-au-Prince where 20 severely malnourished children were being treated by an aid group.
Kaulard said even though international relief workers "were all anticipating this, " and doing their best to get food and water to the people, it is difficult to reach many of the most isolated areas, even by helicopter.
"The logistic, transportation challenge is a major bottleneck, " she said. "We are right back to the situation we had with Gonaives right after the hurricane when all of the bridges leading into the city were cut off."
World Food Program, along with the U.S. Agency for International Development and other relief groups, have responded by working to increase food programs. Also, a USAID-funded food distribution was expanded and UNICEF is funding a nationwide nutrition survey starting next month.
MOST INFANT DEATHS
Even before a string of storms wiped out crops, killed livestock and cut access to remote mountain villages, children in Haiti were endangered. The country has the highest infant mortality rate in the Western Hemisphere for children under 5. Haitian authorities have long reported that 9 percent of children suffer from acute malnutrition, and 23 percent suffer from chronic malnutrition.
Kaulard said she's also become increasingly concerned because many farmers have reported that they were unable to plant in September due to a lack of seeds. That and the lack of foreign donor support for the U.N.'s emergency appeal on behalf of Haiti has her doubly apprehensive.
"The first half of 2009 really looks worrisome for Haiti, " Kaulard said. "We are very concerned. The World Food Program has food resources to cover the needs of two million people and we have enough until January. If we don't get more resources, February will be very tough and the following months even tougher."