SANA'A, Yemen, 21 May 2013 - Born just over a year apart, sisters Onood and Ohood Nassar Al Hajria may face very different futures. Ohood's eyes shine and sparkle as she plays with her younger sibling. Slightly unsure, 3-year-old Onood looks up at her older sister for approval.
When Onood was just 4 months old, her mother noticed something was wrong: "She had a fever and diarrhoea and wasn't like my first daughter," she says. "She was losing weight."
Despite trips to the doctor and the hospital over the next couple of years, it wasn't until a visit from Latifah, a local health volunteer, that someone realized the child wasn't getting enough of the right nutrients and was suffering from malnutrition.
Onood's mother was given a week's supply of therapeutic food and told to return the following week for more.
But she didn't go back.
She and Onood's father were having problems, so she took her daughters and moved in with her mother. She wanted to go back to the hospital, but there was no one to take her – no brothers, no sons, just sisters.
In Yemen, a woman does not go out of the house without a man to accompany her.
And so they stayed at home, mother and child, and Onood got worse. She grew weaker and again suffered from diarrhoea and vomiting.
"I'm really tired, because I want my child to be cured. But every time we go to the hospital or the pharmacy we spend 5,000 riyals [about US$25]," the mother says. "And now we are in debt to the pharmacy of 8,000 riyals [about $40]."
On top of the mounting debts, Onood's father is not satisfied with having two daughters. He yearns for a boy and has said if he doesn't get one, he will marry another woman. His daily wage isn't enough for the four of them to live on.
Onood's mother says, "A boy will not solve our problems, but will create more."
Stopping the cycle
If Onood doesn't get the treatment she needs soon, she will face a very difficult future. She won't die, but she will be short for her age and will not reach her full potential. She will lag behind her peers at school and won't develop properly into adulthood. If she has children, they will likely be small and malnourished – and so the cycle continues.
Thankfully, Latifah understands this situation. In the last year since she has been volunteering for the hospital, she has referred around 55 children with SAM for treatment and always follows up with those who drop out. Onood is one of those, and Latifah has been looking for her since her last appointment. A quick measurement of their upper arm circumference shows that Onood is severely malnourished, while Ohood is healthy.
In 2011, stunting affected more than a quarter of children under 5 around the world. It leaves them at risk for complications from common illnesses that a healthy child could easily recover from. Children with SAM are nine times more likely to die than well-nourished children.
In Yemen, where 58 per cent of children under 5 are suffering from stunting, many people are unaware of the signs to look for and how serious it can be to ignore them.
Although she has already passed the first 1,000 days of development – the critical 'window of opportunity' – it is not too late yet for Onood. The right approach can reverse much of the potential damage that continued malnourishment would bring: 75 per cent of children with SAM who receive appropriate treatment within the scope of a coordinated intervention are expected to recover.
This visit has been a positive one. Having found Onood again, Latifah is determined to enrol her in the programme within the week and has helped the family find a male relative to accompany them. Latifah won't let them drop out again, so there is now hope that the sisters' lives will run similar paths in the future after all.