UNICEF last month celebrated Nepal's progress towards achieving the Millennium Development Goal of reducing child mortality by two-thirds by 2015. However, the goal of cutting malnutrition from around 50 percent to 25 percent remains a daunting one.
These photos from Humla and Mugu are a reminder that all is not well.
Taken by an independent photographer documenting the work of French NGO Action Against Hunger (ACF) in August, they show that last winter's drought is having a major impact in some areas.
ACF started a therapeutic feeding program for children in 10 VDCs of the two districts in June and then had to include 30 percent more severely malnourished children than planned, "indicating a real deterioration in the situation" since its first assessment in February, says ACF's Mireille Seneclauze.
The UN World Food Programme is now delivering emergency rice to Mugu but it won't reach all affected VDCs, and plans to fly in rations to Humla, Jumla, and Dolpa will have to be put on hold this week if donors do not make up a $3.7 million shortfall.
In July and August, WFP and local NGOs distributed food to neighbouring Bajura. A district-wide survey conducted afterward by various agencies found an alarming rate of malnutrition. Seventy percent of children were underweight and 12 percent wasted-the indicator for acute malnutrition. More than 40 percent of kids under two years of age had diarrhoea, fever, or a cough.
Supplying food relief and essential medicines is the immediate need in addressing the crisis in the Karnali, one nutritionist told us, but it's important to remember that 50 percent of children throughout Nepal are malnourished. "Unless underlying causes-including good feeding and hygiene practices, psycho-social support and care for mothers-are addressed, the situation will not improve," he said.
Giving communities the tools to assess the well-being of their children and collectively take action to reduce malnutrition is essential, he added.
Mother and malnourished child attending a food distribution in Dharma, Humla district.
(ALL PICS: ACF/FREDERIC LECLOUX/VU)
Drought, near Natarphu, Mugu district
A malnourished boy in Nehar, Mugu district
ACF staff weigh a baby in Dharma, Humla District
People receiving pitho from ACF staff at a food distribution in Dharma, Humla district.