ADDIS ABABA // As 10-year-old Biruk Nigusie nibbles at the corner of a small foil packet, his tall, graceful mother covers her face with her hands and sobs. Biruk and his sister Tigist, 14, watch silently as Athe Iatseda Herpha weeps for the fate of her children at the family's tiny mud home on a school site in Bishoftu, Ethiopia. She, her husband, Sirag, and Biruk are HIV-positive. Only Tigist has escaped the epidemic that is affecting people in towns and villages along the main motorway between Addis Ababa and Djibouti.
Like many families in the community, the Nigusies are destitute, soon to be made homeless and, for two weeks of every month as they struggle to survive on the US$30 (Dh110) Mr Nigusie makes as a security guard, extremely hungry. The silver packet Biruk clutches contains a nutritional supplement called Plumpy'nut, a high-energy, nutrient-enriched peanut-based paste used in famine relief. It keeps him from starving to death.
More than 25 tonnes of the expensive paste recently arrived in Ethiopia, shipped from France to Djibouti and then transported by road to Save the Children warehouses in Addis Ababa, courtesy of Dubai Cares. On Aug 26 last year Dubai Cares gave US$12,959 to ensure that the supplement reached Ethiopia's hungry schoolchildren in the six regions most affected by recent droughts. According to government figures, there are 6.5 million people in Ethiopia who need emergency nutritional assistance. Of those, 75,000 children like Biruk are severely malnourished.
Aid workers suggest the numbers are conservative and don't count the four million people on emergency programmes run by the government, which for three years provide food or cash for work. Having partnered with Save the Children on several projects last year, Dubai Cares decided to help. The charity was started by Sheikh Mohammed bin Rashid, Ruler of Dubai and Vice President of the UAE, in September 2007 to provide primary education for at least one million children around the world.
Alemtsehai Greisling, Save the Children's project manager for Ethiopia's nutrition programme, says: "Schools have opened for the year but because of the food shortages and fuel costs, providing school materials to children has become unaffordable for poor families and school enrolment is down. "Life-saving, high-energy foods are now being distributed through emergency food centres." Plumpy'nut does not require refrigeration or water and is extremely effective in treating malnourished children.
"It's really a miracle. We see results within two weeks," Ms Greisling says. But it's a short-term answer. This is the third time Biruk has been admitted to the nutritional programme. But with his HIV infection, he needs more than the average two-month supply of supplements. "On average, one child takes three sachets per day for a minimum of two months. That's 160 sachets. If they have HIV then the period could be far longer," she says. "Their weight tends to go up and down according to the treatment they are receiving."
Explaining how children are selected to the programme, Ms Greisling says: "The children will come to local health centres and their middle-upper-arm circumference, weight and height is measured by trained staff in order to check the status of the child and diagnose as to whether it is malnourished." The method used to take the arm measurement, she says, involved a simple tape divided into three sections - green, yellow and red. If a child's arm circumference is in the green zone they are considered healthy. If it is in the yellow zone they are at risk and monitored, but do not receive the highly sought-after supplement.
It is only those in the severely malnourished zone, red, who are given the Plumpy'nut. "Those in the red zone usually only have two or three days to live unless they receive immediate nutritional support," Ms Greisling says. Biruk, who hopes to be a doctor one day, has been in the red zone twice in the past year. His mother said he is doing well, but with the family forced to vacate the one-room home of mud and sticks they stay in free of charge, on land owned by the school where Biruk is enrolled, his future is not assured.
"The Plumpy'nut has been very useful," Mrs Nigusie says. "Biruk has gained weight and strength. He has been discharged from the programme before but he relapsed again because he became very thin. The first time he had to drop out of school. Now he is back in school again. "We get some salary from my husband but it is a struggle with food prices at market rising. When we have food we eat three times a day. When there is none we don't eat.
"We don't have a home but the school has allowed us to live here for some time because they know our circumstances. We have to leave within three months because they need the space. We don't know where to go. We can't rent any house with this salary." A 10-minute drive from the Nigusies, in a small town called Dukem, also on the main motorway, a 30-year-old widowed mother tries to feed Plumpy'nut to her year-old son, Doctor.
Meseret Girma has known she is HIV-positive for six months. Her husband died just before Doctor was born, of tuberculosis. Local health workers suspect he had Aids. Doctor has tested positive for HIV antibodies but it will be another year before his mother and doctors will know whether he is HIV-positive or if he just received his mother's antibodies through her breast milk. He weighed just 4kg when he arrived at the health clinic five months ago. He progressed to 7kg. Until his status is known, he will continue to receive Plumpy'nut to maintain his weight.
Ms Girma and her son have no family nearby and, as she is unable to work regularly because she suffers from anaemia, paralysis in her legs and headaches, she and her son now rely on the generosity of their neighbour, Yiftusirat Kaftiymer. "I don't have any family at all or a house or a job," she says. "Sometimes I have labour work but when I get ill it's difficult to work. I had some land which I have sold and so we rely on that money and are learning handicrafts to try and sell things at market.
"Today we had breakfast because we still have money from the land that I sold. We eat ingera [a traditional Ethiopian bread]. We eat as much as we have. If we have plenty then we eat plenty. If we don't have, we share what we do. "I am struggling to live for my child." Towns like Dukem and Bishoftu are known by aid workers as "high-risk corridors", common across Africa, where desperately poor women prostitute themselves to lorry drivers on the main motorway, so HIV rates are high.
Ethiopia's food crisis has led to an increase in the number of HIV-infected children and adults dropping out of antiretroviral therapy (ART) programmes, because without food the medications are too strong for the patients' bodies, says Wondu Magen, a nutritional worker for Save the Children. Ms Greisling says: "On one recent field mission, people were telling us of a child who collapsed because he was taking ART without enough food. On an empty stomach, the medication is also not as effective.
"At the health centres we have adults telling us they will take the medication away with them, at the staff's insistence, but they won't be taking it because without food it's just too strong." Asked how difficult it is to live with HIV, alongside the struggle for food, Mrs Nigusie breaks down in tears. "I have already given everything up to God," she says, covering her face with her hands. "I just hope my children will live a long life. I wish for Biruk to grow strong and healthy and that someone will look after him and support his education."
Watching on with sad eyes, her daughter says she hopes to be a journalist one day. "I want to write about my family and people like us," she says. "Tell people what it's really like here." firstname.lastname@example.org