Death by starvation - no longer a problem. We have the ways and means to keep alive. Just.
Barwaco and Mohamed come from Nana, a small village way up on the stony Kenyan Ethiopian border. But like millions more children around the world, they owe their lives to this brand of food which is never advertised and is unknown outside disaster spots. The sweet paste, invented by a French scientist, is made under licence to UN children's charity Unicef on an industrial estate outside Le Havre, and its mix of peanut butter, vegetable oils, powdered milk, sugar, vitamins and minerals is the equivalent of royal jelly, açaí berries and chocolate all wrapped into one for malnourished children. It's cheap - a sachet costs about 85p - and because it needs no cooking or added water, children can safely feed themselves on it at home. In just a few years "ready-to-use therapeutic foods" (RUTF) like Plumpy'nut have revolutionised the treatment of severe malnutrition.
One month ago, says Jirma, both Barwaco and Mohamed were at death's door. Their muscles were wasting, their hair was turning orange, and they were showing sure signs of marasmus, a type of malnutrition caused by a diet deficient in protein and carbohydrates. When Jirma first saw them he feared for their lives. Now, with the Plumpy'nut provided by Irish charity Concern Worldwide, they have recovered nearly 10% of their body weight - the difference between life and death for a young child. In another week or two they will move on to a corn and soya blend flour and in two months they should have recovered completely.
"We are not killing people [with hunger] as we did 20 years ago," says Yves Horent, the European community's head of humanitarian aid in Nairobi. "Things have improved enormously. We don't have many deaths from hunger nowadays. We're become very good at keeping people alive technically with foods like Plumpy'nut. We have techniques to save people. We can keep mortality rates low. It's incredibly efficient. We can save children, no problem. Just 20 years ago this would not have been possible. The cost of a life saved is now very cheap - €20-€40 will save a life. We can give vouchers, so people can access food easily. Fifteen years ago that would have been unheard of. We can deal with 20 million people. Now where there is free access or there are no blocks [to humanitarian groups] to working in a country, we can move thousands of tonnes of food. We won't see people dying in thousands again, like in Ethiopia in 1984. People tried their best then, but the science was not as good as now. In the mid-1980s, we had very few professional aid workers and only a few nutritionists," he says.
But while the humanitarian groups have become incredibly good at saving people, the worry is that no one is addressing the causes of growing hunger. "Part of the problem is that we have become expert in a very artificial way now. We can take a child who is almost dead and revive her. But we cannot stop it happening again and again. We cannot prevent the problem," he says.
The reality of emergency aid today, he says, is that the millions of hungry people who are kept on a drip-feed of food aid from governments and the UN are out of sight. More than 100 million people now depend on UN food aid just to survive, not just to get them over a disaster or a temporary emergency, but to stay alive for years at a time. More than 5 million people in Ethiopia, similar numbers in Southeast Asia and sub-Saharan Africa, 1 million in Kenya and more in Burma, Somalia, Yemen, Chad and India are kept permanently just above the starvation levels. There may be no full-scale humanitarian emergencies any more, but people are left in a perpetual state of chronic hunger.
Now there are ominous signs that rich countries are withdrawing even this safety net. Following the recession, countries have pledged less than half the money needed to feed the hungry. Even as hunger is increasing, the World Food Programme is nearly $3bn short and is having to close offices, cut operations and slash rations to millions of people who have no way of earning money to buy food.