The first victims of the rider

By José Antonio Bastos, former President, Doctors Without Borders



Among all world maps you can come across, the most painful and outrageous is certainly the one showing ‘undernutrition hot spots’. These are regions of our planet where still today, in the 21st Century, 3 to 5 million children under five years old die every year because of inadequate nutrition. We are talking about the Sahel countries, this year in the headlines, otherwise rather forgotten; the Horn of Africa, in the spotlight last year, while now all cameras have disappeared; and of some countries in South-East Asia, completely neglected.   

Without question, the images of children affected by acute malnutrition as an extreme representation of Hunger in capitals – the Third Rider of the Apocalypse that Alfons Rodríguez depicts in his work – are part of the collective memory of the last half Century. But we can’t cheat: while our society is well aware of undernutrition, whose view generates rejection, book closure and turned off TV, most of these children become ill and die silently.

‘Severe acute malnutrition’ sounds like medical technical jargon. In practical words, it means children weighing 30% less of what they should, whose debilitated body has lowered defenses against infections which in most cases eventually kill them. Children are undernourished when they do not receive enough nutrients to sustain their growth. When deficiencies become significant, the body uses nutrients from tissues, a process leading to  consumption.  

It is clear that focusing on emergency response only, as it has been the case so far, is irresponsible. Emergency interventions are essential to save lives in the short term, but not enough to solve the problem. Future crises need to be prevented through medium and long term solutions. The health perspective must be part of the response, but cannot be the response.

Nevertheless, there are reasons for hope: cheaper nutritional products produced locally, decentralized treatment and a higher level of involvement by donor countries. Prevention plans, including  distribution of milk-based food for all children aged 6 to 24 months in affected areas, massive distribution of anti-mosquito bednets, basic health measures such as routine vaccinations, and – fundamental – free access for children to health services, see encouraging progress.

All these measures allow to dramatically reduce mortality in small children and babies. Access to health services is crucial, as a healthy child is less vulnerable to malnutrition just like a child correctly nourished is less vulnerable to diseases such as malaria, diarrhoea, or respiratory infections. On top of this come the difficulties related to the context, for example to situations of conflict or displacement.  However, the basic recipes which are known to work seem to be clear.

Alfons Rodríguez says he doesn’t expect to  end hunger and undernutrition. While this is not indeed his responsibility, his work shows and explains the problem, and poses questions.  Representing child malnutrition with images is not a pleasant job, but it is extremely valuable, in addition to that of other actors, because it means joining forces to fight a common battle.







Extract from MSF introduction of the book The Third Rider by Alfons Rodríguez.









© translation by Nicoletta Di Tanno