Hamdullah’s scale: treating childhood malnutrition in Pakistan’s neglected Balochistan province after the floods

October 6, 2010

Hamdullah’s scale: treating childhood malnutrition in Pakistan’s neglected Balochistan province after the floods

Nurse Hamdullah has been working with Médecins Sans Frontières / Doctors Without Borders (MSF) in Pakistan’s neglected Balochistan province for the last decade, treating children suffering from malnutrition.

The monsoon floods forced about 600,000 people to flee from neighbouring Sindh province to Balochistan in Pakistan’s southwest, some of them making a difficult 300km journey to the provincial capital, Quetta, in search of help.

Many people have lost everything – their homes and family members. Tenant farmers are considered the poorest of the poor and they came with nothing. With the influx Hamdullah has seen a wave of severely malnourished children of tenant farmers coming to MSF’s outreach feeding programmes “In Dera Murad Jamali and the surrounding areas I saw many malnourished children in the camps. I admitted 15 to 20 patients to our feeding programme every day,” Hamdullah said.

Food aid provided in the wake of the flood often focuses on fighting hunger and not on treating malnutrition, which cannot do enough to address the needs of children most at risk.

“Treating malnutrition in children under the age of five is essential. This improves their chance at survival while immune system is still developing. When children are severely malnourished they cannot resist the infections and diseases most likely to claim their lives. If not treated in time, the damage malnutrition leaves on their physical and mental state is irreversible,” explained Dr Ahmed Mukhtar, an MSF Medical Coordinator Pakistan.

MSF operates nine outpatient therapeutic feeding programmes across Pakistan through outreach teams who provide systematic medical check-ups and a week’s supply of ready-to-use therapeutic food (RUTF) in sachets. This paste, made from peanuts and milk, is enriched with vitamins and micronutrients that children need to recover quickly.

Currently MSF treats 1,748 children for severe and acute malnutrition in Sindh and Balochistan.

We spent a day with Hamdullah and his three-man team; Ali Sher, Noor Mohammed and Muhammed Iqbal who ensure malnourished children get treated.

09:00: MSF office Quetta

Hamdullah’s nutrition outreach team fill their 4X4-pickup with seven boxes of RUTF sachets, a scale, medicine chest containing antibiotics, a tent, a table and chairs and some clean drinking water. They also pack the patient register; listing the names of young patients and their weight tracked over a three to six week period. We head out on the Sariab Road to the outskirts of Quetta.

09:30: Quetta eastern bypass camp

About 40 tents dot the once densely populated yard of the Muslim Health Clinic compound. Hamdullah is surprised: “Some families have started returning home sooner than we thought. They are anxious to get to their land before winter sets in.”

Within minutes of setting up their post, about 20 young Sindhi girls carrying their younger siblings are already crowded around Hamdullah’s table and scale. They clutch small pieces of paper – evidence of the team’s visit the previous week. The notes bear the child’s name, their weight and the follow-up visit date.

And so begins the ritual that defines proceedings for the day: Ali Sher calls out a name; Hamdullah then confirms this and their village of origin, before weighing and measuring the child. He does a quick calculation to determine progress, and then Noor Mohammed and Muhammed Iqbal hand out a prescribed number of RUTF sachets.


Gulbano Nazir has pushed into the throng of women and children, holding tightly onto her two sons Khalid, 18 months and Hussain, aged three. The floodwaters washed away their mud-walled home near Jacobabad a month ago. She and her husband, Mohammed Rafiq, along with seven other desperate families scraped together the 60,000 PKR (over U$ 600) to pay for a truck ride to Quetta after selling what they had left and borrowing some money.

Khalid was diagnosed with severe and acute malnutrition, but is recovering and has picked up weight rapidly thanks to the nutrient-rich RUTF. He digs into it as soon as Gulbano opens the sachet for him.

Despite lacking vital information about conditions in Jacobabad, the family will return home to their devastated village. But this could mean Khalid’s long-term recovery might be as uncertain as the family’s future.

“I just want to go home. Camp life is tough and winter is coming,” said Galbanum. All Khalid can depend on for now is the 14 sachets of RUTF his mother is carrying back to their tent.

This supply should see him through until the family reaches another transit camp near Dera Murad Jamali on their route back to Jacobabad where MSF also provides outreach feeding care.

13:00 Camp 2 near the Quetta railway line

The sun beats down on this 300 tent camp where the team sets up shop in the parched landscape. Their tent is barely erect, and already desperate mothers trying to shade their crying children from the sun, jostle to get their babies onto Hamdullah’s scale.

When Hakim Zadi and her son, Akhsa Banu, reach Hamdullah’s table, he takes a look at the child and reaches into a box for a coloured-coded MUAC (Mid and Upper Arm Circumference) bracelet. He slips it around Akhsa’s tiny left arm and measures it. The arrows point to the red zone – a circumference of less than 110mm.

“For an 18 month-old this child is severely malnourished,” Hamdullah said, handing Hakim a supply of RUTF sachets.


The outreach team head back to the office and for afternoon prayers; having weighed and measured nearly 200 patients and distributed just over 50kg of RUTF to more than 40 patients.

“It makes me feel good when the child’s condition improves with every visit. People might be moving back home now but there is more to be done because the effects of the floods aren’t over yet,” Hamdullah said.

Since 1988 Médecins Sans Frontières has been working in Pakistani assisting people suffering from the effects of armed conflicts, poor access to health care and natural disasters.

Today 1,198 Pakistani and 135 international MSF staff conduct medical activities to providing rapid response to people affected by the floods disaster, while our work in more than 15 locations in Khyber Pakhtunkhwa, Federally Administered Tribal Areas, Punjab, Balochistan and Sindh province continues

To ensure the independence of our medical work, MSF relies solely on private financial donations to fund its activities in Pakistan and refuses funding from any government, donor agency, or from any military or politically affiliated group.

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