Inside the Médecins Sans Frontières health clinic on the outskirts of the Dagahaley zone, Dadaab refugee camp in Kenya, September 2011. Dominic Nahr / telegraph.co.uk

By Sally Williams
17 September 2011 It was the death of their last cow that did it for Abdi. He told his wife, Sarura, and their four children that they had to leave. In Bakool, Somalia, they packed some clothes and cooking pots and set out for Dadaab, the world’s largest refugee camp, on the edge of Kenya, a 200-mile walk to the south-west. It took 28 days; all they had was a handful of rice and some black tea. We meet them in a queue at the entry point to the camp. ‘Four years ago she was very beautiful,’ Abdi says of his wife. ‘She was fat. This is not the wife I married.’ Sarura is long-limbed with an oval Modigliani face. But hunger has made her stooped and drawn. The children look small, baggy and elderly. As a fully adult male Abdi is quite a minority here as most of the men are either at home in lawless Somalia, trying to protect what’s left, or have been killed. Abdi is consoled by the thought that one day the hunger will go and his old wife will come back. […] The journey to Dadaab, it becomes clear, is like walking a tightrope across the valley of death. Girls are raped, even little ones from primary school. ‘A third of our rape cases are against boys,’ Camilla Jones, a child protection adviser with Save the Children, says. ‘That is just the reported cases.’ For Somali women and children, the price of rape is shame. ‘We have to work on self-esteem,’ the helper says. It is possible to recover from extreme malnutrition in four to six weeks. But, you suspect, emotionally and psychologically, there is no recovery. […] The main feature of life at Dadaab is queuing. It starts when you arrive, and you are sorted into neat lines – large families (the template goes up to 17 children), small families, women- and men-only (Somalis prefer segregation). Today the queue at Ifo reception is already 500-long. Once through the gate, refugees will be fingerprinted, wristbanded and weighed, and will collect emergency rations to last 21 days: a scoop of maize flour, salt and split yellow peas. (Those marked ‘priority’ are fast-tracked to another queue to be fed high-energy biscuits.) Within the next three weeks, on an allocated day, they will queue outside the Registration Centre, to become official refugees and get a ration card, and, thereafter, twice-weekly food distributions. I meet one woman in the line for MSF’s clinic for the severely malnourished, in the outskirts of Dagahaley, who is still queuing from the day before. Her baby is asleep in a shawl wrapped around her back. The baby’s sleep is much too still. This is the kind of detail visitors to Dadaab pick up, in the way that tourists pick up information about bus timetables. You learn that malnutrition has a ‘flat effect’ – children stop playing or moving about. To keep going, the body starts consuming itself – going for the protein in muscles. We know about distended bellies (the result of bacterial overgrowth in the gut) from television, but starving children also have burn-like lesions on their skin, and a ‘flaking paint’ type appearance. Hair becomes brittle, easy to pull out, and tinged with red. […]

Famine in Africa: inside Dadaab, the world’s largest refugee camp