Theresa Machirori, a thirteen-year-old student in the Zimbabwean capital, Harare, has become used to the morning routine of washing her face, putting on a tattered uniform and going to school without breakfast.

Once one of the bright class stars, her academic performance has declined and she often drifts off to sleep during lessons. When she gets home to the working class suburb of Mabvuku in the afternoon, she has a cup of black tea before eating the evening meal of vegetables and sadza – the national maizemeal staple - with her parents and three brothers.

It is a diet the Machirori family have subsisted on for the past three years since the father, John, was retrenched when the cement manufacturing company where he worked ran into financial difficulties.

"That my children fight over food is now a regular occurrence that we have almost become used to, but when I see them quarrelling during a meal, my heart is always filled with pain, even though I take care not to show it," he told IRIN.

"However, I think we are lucky, in a way, because I know there are so many families out there that are literally surviving on water, and there are many deaths that are taking place quietly because of lack of food," Machirori said.

The family is among thousands of households that Harare's municipal authority says are surviving on one meal a day. Food insecurity in urban areas continues to worsen as Zimbabwe's official inflation rate of more than 6,000 percent makes basic commodities both scarce and unaffordable.

Clare Zunguza, a nutritionist working for the Harare City Council's health department, recently told the parliamentary committee on health that "Most families are not eating anything in the morning and afternoon, and only have one meal in the evening, hence malnutrition is now prevalent in Harare."

Kwashiorkor rising steeply

Harare local authorities recently reported that cases of kwashiorkor had risen by 43.7 percent in 2006, compared to the previous year, and the Zimbabwe Demographic and Health Survey said conditions such as stunting and underweight, associated with poor food quality and quantity, were increasing in the country's 10 provinces.

Kwashiorkor is a malnutrition disease that results from inadequate protein intake, even when the diet is otherwise adequate. Early symptoms include fatigue, irritability and lethargy. As protein deprivation continues, there can be stunting, loss of muscle mass, generalised swelling, and decreased immunity. A large, protuberant belly is common, as are skin conditions, changes in pigmentation and thinning hair.

Zunguza said at least 30 percent of children under the age of five were malnourished, and recommended that supplementary feeding schemes be increased, specifically among primary school pupils most affected by food shortages.

Before the economy began its sharp decline in 2000, and the donor community scaled down operations in the country, citing a hostile environment, most primary schools benefited from supplementary feeding schemes; now schools in only three of Harare's most populous suburbs receive free food supplements.

"Shortage of nutrients among pregnant women in high-density suburbs is on the increase, resulting in them giving birth to underweight children, who are at the risk of developing complications and infections," Zunguza said. People living with HIV and AIDS, three-quarters of whom were the head of the family, were also affected by the scarcity of nutritious food.

Harare's acting director of health, Dr Stanley Mungofa, said no deaths related to malnutrition had been recorded, but admitted to a parliamentary committee that the acute shortages of water had given rise to outbreaks of diarrhoea and skin diseases. "We have had increases which are above what we normally see."

The government declared 2007 a year of drought, and the Famine Early Warning System (FEWSNET) has said Zimbabwe would have to import more than one million metric tonnes of cereals to augment poor harvests that will leave about 4.1 million people, or more than a third of the population, in need of food aid by early next year.

A vegetarian nation

Murisi Zwizwai, a member of parliament for the opposition Movement for Democratic Change (MDC) who also sits on the parliamentary committee on health, said the problem of malnutrition was a "big worry that has affected all corners of the country".

"The majority of the people in this country live on less than US$1 per day, meaning that the poverty datum line is pathetic; as a result they cannot afford to buy whatever food is available," he commented.

"Add to that the fact that foodstuffs with nutritional value, such as eggs, meat and milk, are in short supply, and where they can be found they are being sold on the black market at exorbitant prices, and you can see the whole scenario is tragic," Zwizwai told IRIN.

In June the government introduced price controls, forcing retailers to reduce commodity prices by 50 percent. Manufacturers said the prices were unrealistic; they could not produce at a loss and stay in business. Since the rush that emptied shop shelves of whatever was available at the cheaper prices, the shelves have mostly stayed empty.

"We have been reduced to a vegetarian country because even kapenta [a traditionally cheap small dried fish] that is rich in protein is difficult to obtain from traditional sources," Zwizwai said.

"The Grain Marketing Board [the state-controlled company with a monopoly on buying and selling maize] is seizing maize from urbanites, who would have sourced it from areas that had relatively good harvests," further tightening supplies.

He pointed out that the current commodity shortages were taking a toll on school children, hospital patients and prison inmates, who now had to rely on their relatives and families for food, "but that is proving difficult because those very people who are supposed to help them are also starving".

Zwizwai said government had failed to put in place mechanisms to ensure that vulnerable groups of society, such as AIDS patients and children, were given priority in the distribution of the little food available.

Plight Mbiri, 44, who is living with HIV/AIDS in the small town of Kadoma, about 200km southwest of Harare, recently moved to Harare to live with a brother because his poor health made it increasingly difficult to fend for himself.

Mbiri's wife left him two years ago when he became critically ill and he has relied on donations from his brother, who works as a bank teller in Harare, since he lost his job due to poor health.

"Harare seems to be better in terms of the availability of foodstuffs and drugs. I was going through hell, living alone in Kadoma where I used to work as a teacher, because having TB I needed good food to complement the drugs I was taking, when they were available.

"I am sure my condition would be better if I could afford at least two good meals a day and while my brother is doing his best, I know he is struggling here in the capital," Mbiri told IRIN. "Even when money is available, it is a struggle to get the food to buy."