Mairi Maguire, a Red Cross nurse, supervises a supplementary feeding centre being run by the British/Australian Red Cross in a camp for over 100,000 people who have been displaced by fighting to the remote town of Gereida, in South Darfur. This is her diary.

Monday 7th May

I saw a six-month-old boy this morning. He's called Musa. His mother is giving him breast milk – and water to drink. The breast milk is good – but if you quench a child's thirst with water, then he takes in less milk than he needs. Besides which, at six months old, a child needs to be beginning to take solid food. This wee boy weighed much less than he should. We advised the mother to breastfeed him as often as she could – not even to wait until he was crying for food, but to offer him the breast regularly.We also gave her a ration of our famous 'premix' (corn, soya, oil, and sugar). We'll keep an eye on him over the next few weeks and hope that he improves rapidly.

Tuesday 8th May

We had one mother, Fathia, in with her baby this morning. She had been coming regularly to us for two months. Her baby had been two months premature, because the mother had been ill (what sounds like jaundice). The baby, Sabba, must have been tiny and was probably lucky to survive. The baby had been malnourished when she came to us two months ago – about the weight of the average new-born baby. In our programme she had slowly but surely gained a bit of extra weight – until last week, when she had malaria. In that week she lost all the weight that she had slowly and painstakingly put on over the last two months. Now she also had diarrhoea, and had completely lost her appetite.

The mother's supply of breast milk was great. We encouraged her to continue, and indeed increase, the frequency of breastfeeding, and to give small amounts of food as often as the baby would take it. We checked to make sure that the malaria has cleared up, and that the diarrhoea wasn't being caused by anything we could treat. Everything checked out okay so we've asked her to come back on Saturday to let us see how the baby is doing. If she is not showing signs of improving by then I may have to ask the centre that cares for severely malnourished children to admit her.

In the early evening, we had one rare bit of social life. It's Red Cross Day, and the local Red Crescent and ourselves organised an 'event' in the afternoon. We had a short football match (with a temperature of 45 degrees Celsius, there's not much incentive to play for one-and-a-half hours) and a couple of races, the best of which was the donkey derby. The local team beat the International Red Cross and Red Crescent Movement soundly. A good time was had by all!

Thursday 17th May 

Penny from the community therapeutic centre is just about to go off for a well-deserved long weekend and I'll be covering for her, so I spent the morning in the centre to familiarise myself a bit more with the children and the routine. The biggest difference is in the daily care unit, as those are really quite sick children, and there is a lot of clinical care involved. There was one child, Amira, who had had diarrhoea and vomiting, which had stopped, but she didn't want to eat or drink. Some of the sicker children have a tube put down their throat into their stomachs so that we can feed them and give them fluids. The mothers are then taught how to give the necessary fluids down this tube. We have treated Amira like this for a couple of days, and will have to hope for the best.

Saturday 19th May  

Amira came in today and she was fine. Her tube had become loose last night, and the mother had, quite properly, taken it out. By that time, though, she had perked up considerably and was eating her 'special biscuit' well, and drinking her oral rehydration fluid thirstily. This morning, she is a bright little button.

In the afternoon, just as we were closing, a mother came in with a little girl of about four. She was the classic picture of the starving child – moon face, and swollen arms and legs. My first thought was Kwashiorkor, which is a type of very serious acute malnutrition, which, fortunately, we don't see a lot of. We admitted the child into the centre, and I asked for some tests to be done to be sure that that is what it really was. (We have a small laboratory that can do some basic tests). Kidney diseases can also cause this kind of swelling and the treatment is very different, and will have to be done in hospital rather than the feeding centre. Unfortunately, we weren't able to do all the tests necessary before the centre closed for the night. She will have to complete them tomorrow.

Sunday 20th May

The little girl from yesterday, Eman, didn't show up until 10 o'clock today. I'd already sent someone out to look for her when the mother appeared. I'm revising my first impression of her having Kwashiorkor. Normally these children are miserable – and she isn't. She doesn't seem particularly fractious, nor is she vomiting – both of which you usually see with Kwashiorkor. She's even lost a bit of her swelling since yesterday. Unfortunately, at midday, she still hasn't produced a specimen of urine for us to check it out – and that the best quick diagnostic tool I have. In the meantime, we have her on high calorie but low protein food. If it is her kidneys that will only do her good – and if it is Kwashiorkor, it's the first stage of treatment. I asked the doctor to see her – and she's not sure either of what it is. We've managed to check her urine, and she is passing quite a lot of protein, which might suggest kidney problems rather than Kwashiorkor.

In the supplementary feeding centre we had one little boy, Adam, who we kept there all day. He'd had diarrhoea for four days – and during that time his mother had giving him almost nothing to eat or drink. The poor wee mite was dehydrated and ravenous. We kept him in the centre to give him adequate fluids, and a bit to eat. At the end of the day, he still wasn't too bright, so I've transferred him to the therapeutic centre for a bit more intensive care. The job of the supplementary feeding centre is to care for children with 'simple' malnutrition – once it gets more complicated, we transfer them to the therapeutic centre.

Monday 21st May 

Eman is definitely a bit better. The swelling is much less. We'll carry on as we are for a few days, and see how she does. We had to transfer wee Adam to the hospital this afternoon. He had slowly deteriorated during the day, and by the end of the afternoon was quite ill - toxic and with a fever. We checked, and it was not malaria. Probably an infection somewhere – but our diagnostic tools don't allow us to find out what or where, and as we only offer day care we had to transfer him.

Tuesday 22nd May  

All the children in the therapeutic centre seem to be progressing well. Amira, who we were quite worried about last week, has improved enough that we are transferring her onto the home-based programme. That means that she'll only have to come once a week instead of daily. Eman has lost some more of her swelling. In fact, all the children in the therapeutic centre seemed so well that I only spent an hour there, and then went over to my own unit.

Tuesday is one of the market days in Gereida, and we often get a lot of mothers bringing their child in while they're at the market anyway – so it's always a busy day and we usually have quite a few new admissions. Our staff spent quite a lot of time with the mothers of new admissions advising them on childcare practises. Last year, most of the children admitted had been recently displaced in traumatic circumstances – this year, what we're finding is that most of the children in our programme are receiving poor care within their families.

Calorie-poor thin porridge is introduced to the child's diet at a time when they should only be receiving their mother's milk. By the time they should be receiving more food, they are still only receiving thin porridge and milk. At seven months old, most children are showing early signs of malnutrition. By the time a child is one year old, chronic malnutrition is often established. When the mother falls pregnant again, she abruptly stops breast-feeding. The child is not used to eating the family food – and within one month he is in our programme with acute malnutrition on top of his chronic malnutrition. In addition, the whole problem is worsened by the belief that the child should be fed a minimum while he's ill (Remember, from our own childhood 'Feed a cold. Starve a fever'?) Finally, mothers have to spend long times away from their children fetching water and firewood, and often another child is the carer while the mother is gone. All these are problems in child care that take a lot longer to resolve than simple lack of food.

Read more about Mairi's work