Photos of skeletal babies posted in a health center in northwest Cote d’Ivoire portray not just fallout from the country’s conflict but a longstanding problem thrown into the spotlight by the arrival of aid groups.

“Severe and moderate malnutrition have long existed in this region,” said Abdoulaye Ouattara, a doctor who runs a nutritional center in Madinani, a town 80 km east of the regional capital Odienne. “Because of the war, humanitarian groups came to this region and this allowed us to address some health problems that existed well before the crisis.”

In the main hallway of the Madinani nutritional center - run with support from UNICEF and the UN World Food Programme backed by international donors - are scores of photos of severely malnourished infants who have come through the centre.

Health officials and aid workers in the region said five years of unrest has exacerbated poverty, and hand-in-hand with that, malnutrition.

Cut off

The 2002 rebellion cut the northern half of the country off from the government-controlled south, sent civil servants fleeing and shut down financial institutions. People in Odienne and nearby villages told IRIN families eat one or sometimes two meals a day, compared to three before the conflict.

But even the pre-2002 diet of three meals a day did not necessarily mean that babies received the nutrients they needed. "Here, malnutrition is largely a problem of dietary habits; infants are often deprived of foods and nutrients they need," Fatimata Bamba, government health director for Odienne, told IRIN. She said women’s constant work in the fields can also mean infants don't get the attention and diet they require.

The economy is also a factor, with northern Cote d'Ivoire historically lagging behind the south in socio-economic conditions. “The north has definitely been disadvantaged compared to the south in health, education and infrastructure," said Arnim Langer, research officer with the London-based Centre for Research on Inequality, Human Security and Ethnicity.

These disparities - stemming from colonial and post-colonial development policies - play into the country's current conflict. “The disadvantage of the north in socio-economic terms compared to the south has been and continues to be a major issue."

Influx of NGOs

Today, Odienne residents are used to seeing aid agencies milling around town, but that was not the case before the 2002 rebellion. The head of WFP’s Odienne office, Marc Sibiri Dao, said the region has not historically been on the radar screens of aid organisations. “In the past there was very little humanitarian intervention in the region. We could say it was more or less abandoned.”

Ouattara at the Madinani health center said thanks to assistance by aid organisations and donors since early in the conflict, health workers have been able to carry out studies on malnutrition in the area as well as awareness campaigns on infant health and the signs of malnutrition.

“In the past, generally women would come with their infants only when the child had an associated illness, such as a bad cough or a fever or diarrhea. It’s when they get here we see that it’s a case of malnutrition - and we tell the women, this is malnutrition and it can be treated. The women are skeptical. But we’ve started to go around educating women about malnutrition; they are starting to come now.”

Madinani has long had a health center but not the resources for the surveys, education campaigns and nutritional therapy it is now able to provide. Still, all support staff - cooks, community health educators, and others - are currently working on a volunteer basis, Ouattara said.

Health director Bamba said combating infant malnutrition in the region depends heavily on grassroots education and participation. “Malnutrition cannot be detected unless communities are involved [in the community’s health] and know what malnutrition is.”

With government health workers gradually returning to the region, Bamba said, they will be working with UNICEF and other partners to step up basic health and nutrition training in rural communities.

Health officials in the region hope they will have adequate resources to continue the work. "With the help of aid organisations we have been able to start to tackle problems that existed long before the crisis. Now the question is how this will all go after they leave."