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— Suhani Bunglani fans flies away from her two baby girls as one sleeps motionless while the other stares without blinking at the roof of their tent, her empty belly bulging beneath a green flowered shirt.
Their newborn sister already died on the ground inside this steamy shelter at just 4 days old, after the family's escape from violent floods that drowned a huge swath of Pakistan. Now the girls, ages 1 and 2, are slowly starving, with shriveled arms and legs as fragile as twigs.
More than 100,000 children left homeless by Pakistan's floods are in danger of dying because they simply do not have enough to eat, according to UNICEF. Children already weak from living on too little food in poor rural areas before the floods are fighting to stay alive, as diarrhea, respiratory diseases and malaria attack their emaciated bodies.
Doctors roaming the 100-degree (38-degree Celsius) camp that reeks of urine and animal manure have warned Bunglani three times to take her children to the hospital, or they will die.
The mother says she knows they need help, but she cannot leave the tent without her husband's consent. She must stay until he returns, even if it means risking her daughters' lives.
"I am waiting for my husband," she says, still fanning flies from the sweating babies. "He is coming."
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The floodwaters that began swamping a section of Pakistan larger than Florida six weeks ago continue to inundate new areas, forcing even more people to flee. At least 18 million have already been affected, and nearly half of them are homeless. Many have been herded into crude, crowded camps or left to fend for themselves along roads.
But doctors warn the real catastrophe is moving much slower than the murky water. About 105,000 kids younger than 5 are at risk of dying from severe acute malnutrition over the next six months, UNICEF estimates.
"You're seeing children who were probably very close to the brink of being malnourished, and the emergency has just pushed them over the edge," says Erin Boyd, a UNICEF emergency nutritionist working in southern Pakistan. "There's just not the capacity to treat this level of severe acute malnutrition."
The U.N.'s World Food Program alone has fed more than 4 million people since the crisis began, distributing monthly rations that include nutrition-packed foods for children. But the sheer geographic and human scale of the disaster is overwhelming, and U.N. Secretary-General Ban Ki-moon has called it the worst he has ever seen.
Even now, after the water has receded in many areas, some families who refused to abandon their villages remain marooned on islands cut off from all transport. The lucky ones sprint and dive for supplies dropped by choppers hovering above. But not everyone is being reached.
Inside the government-run Railway Hospital in the southern town of Sukkur, deep in Pakistan's agriculture bread basket, the aid group Doctors Without Borders has already converted one ward into an inpatient feeding center. Some babies weighing a fraction of what's normal wail and gasp on diarrhea-stained sheets, while others wince quietly as if trying to find the strength to cry. Some little cheeks are sunken in. Others have hollow eyes or bottoms that are merely bones covered by folds of scaly, wrinkled skin.
Their mothers sit on the beds beside them, spoon-feeding milk and pinches of Plumpy'nut, the sweet peanut butter-based nutritional paste dubbed 'chocolate' by the ward's doctors. Many of the women are unable to produce breast milk because they are weak and ill themselves. Some are already pregnant again in an area where illiteracy is high and girls often marry at 12 or 13 and produce back-to-back babies for years to come. Death, especially among newborns, is expected here, where even before the floods a quarter of babies were born underweight.
Janat Khosa's 3-year-old grandson is one of the worst cases in the ward, with chopstick-thin arms and legs, along with suspected tuberculosis complicating his recovery.
"He was well. He was walking and running before the flood came," Khosa says. "After the flood he got diarrhea. He did not eat."
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Bunglani says her two baby girls have had little to eat since the Indus River jumped its banks and turned one-fifth of the country into a muddy lake. She was working in the field when the water began surging, leaving her just enough time to grab a baby under each arm and run to safety.
The military transported the extended family to the camp on the outskirts of Sukkur, where she said they typically receive one meal a day consisting of rice, vegetables or lentils. There is nothing for the babies, and the newborn simply was not strong enough to survive.
"They are getting bread. They don't have milk. She can eat rice," Bunglani says, pointing to Sughra, 2. "But the younger one cannot."
In the past day, Sughra has stopped eating altogether. She will not take rice or any other food. She just turns her head and shoves her mother's hand away.
The little one, Heleema, 1, cannot sit on her own without support, even though she should be getting ready to walk by now.
People from neighboring tents begin to gather, urging Bunglani to allow the doctors to take her children to the hospital. Finally, her brother-in-law arrives and gives the OK. Bunglani grabs both girls and begins walking to the truck, waiting on the road, where their grandfather joins them. He will escort her, guaranteeing that her husband will approve of the decision.
"These kids are everything to me," Bunglani says. "I am worried about them, and everybody can see what condition they are in."
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Post-flood data are lacking, but the World Health Organization says about 30 percent to 35 percent of children in Pakistan had stunted growth before the calamity, a sign of chronic malnutrition. Farming families have now been flushed from their homes, losing the vital crops and livestock that were sustaining them in one of the country's poorest areas.
Children under 5 are the most vulnerable. Their tiny immune systems are not yet strong enough to fight off diseases. When essential vitamins and nutrients are severely lacking from their diets, they are left defenseless.
Feeding centers had to be established from scratch in most parts of Pakistan. Many organizations were slow to respond to the need, and filthy public hospitals are now overflowing with sick children stacked sometimes three to a bed.
"We are very, very deeply concerned," says Sylvain Groulx, project coordinator for Doctors Without Borders in Sukkur, who has teams canvassing 200 camps in search of malnourished children. "You can have some serious, serious physical consequences on their health and very long term, and it can reach death."
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Once Bunglani finally arrives at the hospital, doctors quickly examine the babies. The youngest, who's been suffering diarrhea since the floods, weighs less than 8 pounds (3.4 kilograms) — about 2 pounds (1 kilogram) shy of where she should be. The older one weighs only 2 pounds (1 kilogram) more, about 4 pounds (nearly 2 kilos) below her target weight.
When a nurse hands Sughra a brown plastic cup filled with milk formula, she snatches it with both hands and gulps until every drop is gone. Then she reaches for more.
Some children are much worse off. They arrive comatose and severely dehydrated or covered in scabby skin that is ripe for infection due to a lack of protein and vitamins and minerals.
The ward itself is clean, air-conditioned and filled with colorful balloons and toys. It is a welcome break from life in the camp, and Bunglani's girls appear more alert within just a few hours.
They sleep side-by-side, sucking their thumbs, as their mother hovers over them on the bed. They, and the 22 others here, are the lucky ones. And for now, they are safe.
But Bunglani is already thinking about tomorrow and how she and her family will survive in the camp. She looks to the ceiling and lifts her open palms. Only God knows.
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Associated Press writer Frank Jordans in Geneva contributed to this report.
