PORT-AU-PRINCE, Haiti — Witney Joselene lay in a near catatonic state in a tent at the General Hospital, her legs twig-thin, skin blotchy, eyes glassy. When a nurse inadvertently bumped her metal crib, the 9-month-old didn't even twitch.
Within hours, she was dead.
"There's nothing we could've done for her at that time," said Daphne Lamarre, a nurse. "It was too late."
Food and nutrition experts in Haiti worry that cases like Whitney's — who died Feb. 24 of malnutrition complicated by pneumonia — will increase as the quake-battered country struggles to provide adequate shelter, potable water and sanitary living conditions for tens of thousands of children living in camps.
Although nurses and food experts say it's still too early to determine the extent of malnutrition cases, they say it's a growing problem as Haitians cope with squalor in tent cities, unhealthy food preparation and the rupture of livelihood in a country where hunger has been a perennial concern.
"We have no clear figures, but acute malnutrition is definitely a problem," said Anna Horner, a nutrition expert with the United Nations World Food Program. Horner and others fear acute malnutrition rates will only exacerbate as the rainy season comes this month and thousands of camp dwellers in Port-au-Prince and surrounding areas still lack the sanitary living conditions and sufficient shelter they need to avert disease and illness.
Shifting from emergency response to more long-term relief, humanitarian groups in Haiti are trying to stamp out future cases. The groups have targeted the overcrowded camps where the displaced people have decamped. Nurses watch out for children who show symptoms of acute malnutrition: tiny arms, whose circumference they measure.
Agencies such as WFP are distributing high-energy biscuits to pregnant and nursing mothers, and nutrient-rich peanut paste to children with severe acute malnutrition. They also are trying to educate camp dwellers about the best ways to prepare their food where hygiene and clean water are scant.
In the Martissant slum of Carrefour, a Port-au-Prince suburb, women and their ill children come to a classroom-turned-clinic behind one of the country's 500 camps. They line up seeking medication for diarrhea, fevers, and vomiting. Pediatricians from the International Medical Corps examine the children and those who are malnourished are referred to the General Hospital in downtown Port-au-Prince.
Samuel Abelard, a pharmacist who has worked at the clinic since Feb. 22, said many of the parents he's seen in the Martissant clinic lack access to basics such as milk, vegetables and protein. Rice alone, the primary foodstuff relief agencies have distributed in the earthquake's aftermath, won't keep the more serious cases of malnutrition at bay, he added.
The distribution methods, Abelard added, are too slow to reach the hungry.
"The best way is to come to the camps and give out the food there with security and guards," Abelard said.
Relief agencies counter that the ration card system is the safest and most efficient way to ensure the hungry and the vulnerable get served. One mother recently brought her 9-year-old son for treatment; she admitted she has only been able to feed him one or two meals a day. The only food she's received, she said, is from generous neighbors. She never got a ration card to obtain a 55-pound bag of rice.
"The people giving the cards are not my friends," said Naveni Derivo, 46.
At the General Hospital in downtown Port-au-Prince, where the quake's injured and amputated hobble around on crutches, mostly single mothers — teenagers and adults — shuffle in with their malnourished children.
In an oven-hot tent on the hospital grounds, nurses with Concern Worldwide, an Irish charity that has distributed water, soap and temporary latrines to Port-au-Prince-area slums, feed the hungry and ill children; some use IVs to be hydrated. A scale used to weigh kids hangs from the tent's ceiling.
A nurse and nutritionist with Concern said she hasn't seen a spike in admissions but there hasn't been an abatement, either. Since late January, the clinic has logged about 20 cases a week for severely malnourished children.
Witney Joselene's death was the fifth that Concern Worldwide officials have since late January, said Bernie Feeney, a nurse and nutritionist.