At six months old, Alexis was malnourished. His mother, Natacha, lives alone with her three children in Bowe, a small farming village in northern Burkina Faso. She grows millet but her small field provides only enough food for four months of the year. When the period of the hunger gap - the months when the previous year’s harvest has run out and the next harvest is yet to come – arrives, she has nothing left and her children become vulnerable to malnutrition. Malnutrition is a medical and humanitarian emergency that contributes to the deaths of between 3.5 and 5 million children younger than five each year. Those most vulnerable to under-nutrition, and who suffer the most devastating and long-term consequences, are young children between the ages of six months to two years old. Although people usually associate malnutrition with famine and disasters, it is in fact a chronic condition in many places where we work – a silent killer out of the media spotlight. There are many children in Alexis’ situation who don’t get the nutrients they need to grow and be healthy. Alexis is now safe. He was able to be treated for malnutrition at home by a revolutionary new method using a nutrient rich paste. He and his mother need only go to the MSF feeding centre once a week to be monitored and pick up the supplies. This means his mother doesn’t have to choose between staying with Alexis in a hospital or caring for her other two children at home. Alexis has been saved from falling into a severe form of malnutrition at a critical moment in his development. For very young children, this period between six months to two years old represents a unique window of opportunity when critical development takes place. So in order to develop healthily, children must have a diet rich in nutrients. This diet must centre on good maternal nutrition and breastfeeding for the first six months followed by the introduction of a nutritious and diverse complementary diet containing some animal source foods, such as milk, meat, and eggs. If a child is not given these nutritious foods at this point, they will become malnourished. The consequences of a poor diet at this time for young children include long-term poor health, disability and poor educational and development outcomes. After the age of two, much of the damage from malnutrition is irreversible. In places where malnutrition is endemic, such as South Asia, the Sahel, and the Horn of Africa, many families – like Natacha’s family - simply cannot afford to provide the nutritious – and more expensive – food young children need for good health. Instead, children struggle to survive on a diet of little more than cereal porridges, millet, maize, or rice – a diet that lacks many essential nutrients. Through our experience and work in areas affected by malnutrition, MSF has demonstrated the effectiveness of therapeutic and complementary nutrient rich foods to both treat children suffering from severe malnutrition and also as an effective means to prevent vulnerable children falling in to severe malnutrition. As a result, three years ago MSF launched a nutrition campaign to raise awareness about the devastation that childhood malnutrition causes and to call for more effective ways to tackle it. First and foremost we called for a greater focus on the quality of nutrition offered to young children in food aid in order that they might develop more healthily. There have been some positive developments: The World Food Programme is now adopting a new nutrition strategy which will lead to the reformulation of its food, including new products with animal source protein for children under two years old. However the implementation of this policy will strongly depend on the willingness of donors to fund it. More broadly, to target the root causes of malnutrition - and to prevent the need for treatment of malnutrition on a large scale - we are pushing for children to be protected from becoming malnourished in the first place by ensuring they have access to adequate food. In the hunger seasons, as we have seen, many children become vulnerable to malnutrition. By providing therapeutic food to children during these hunger periods, we are able to prevent them becoming malnourished. MSF is pushing therefore for a reform both of the quality of food assistance provided for young children and also for a change in the way such food assistance is delivered in food programmes to the most at-risk families. MSF has responded to malnutrition in developing countries since the organisation’s inception 40 years ago. In the last two years, MSF has treated more than 500,000 malnourished children.