Nurse Serat Amin works in the world's largest refugee camp treating the stream of starving children coming into Kenya from famine-struck Somalia, and although he has painful memories of the children who have died, watching the weak get stronger gives him the courage to carry on.
"You can see if a child is getting better just from the face of the parent," he said. "Making a difference is what keeps me here."
Amin works at a stabilization ward at the International Rescue Committee hospital in the Dadaab refugee camp, where dozens of tiny children with stick-thin limbs and oversize heads loll on plastic mattresses. Mothers use their fringed shawls to flap the humid aid around their babies' faces while patient nurses poke intravenous needles into tiny hands. Amin, walking about the ward in his yellow T-shirt, knows them all.
"Most come in here very sick. Mihag was unconscious when he came," said Amin, speaking of a tiny 7-month-old the same size as an infant. "But today he is picking up a bit."
The child, which weighed as much as a newborn when he arrived, has put on 3.5 ounces (100 grams) in the past few days. The wailing babies are weighed in a wicker basket suspended from the ceiling.
The U.N. says parts of Somalia held by Islamist rebels are suffering from famine, and a total of 11.3 million people in the Horn of Africa need aid. Amin said the situation is the worst he's seen it _ they've had up to 42 babies in his ward for malnourished babies at a time, a sevenfold increase at the hospital since the beginning of the year. The hospital is just one of three treating Somalis refugees in Dadaab camp.
Most of the children are also suffering from pneumonia and other diseases after hunger weakened their immune systems. That's particularly painful for Amin: his own cousin lost his eyesight after suffering from malnutrition and measles. It's what led him into nutritional medicine in the first place.
Now the wards are full of hungry babies with medical complications. On Friday, there were eight more patients than beds, so women had to share overnight.
"I've asked UNICEF to come with some tents so we can set them up outside and start treating more people," said Amin.
The children come in with two types of malnutrition: marasmus, or straightforward starvation where the child is so thin its skin stands up in folds when pinched, and kwashiorkor, where the child has had food but no protein or nutrients.
Habiba Dubow's son Abdirahman is one year old and weighs nearly 10 pounds (4.5 kilograms). He should weigh 22 pounds (10 kilograms). He is so thin his tiny ribs are clear through his skin and they barely lift with his breathing. When his mother takes his shirt off, his limbs flop back onto the bed and his eyes roll back in his head until only the whites are showing. He is too weak to cry.
"We walked here for 20 days after we lost all our cattle," she said. "He got sick on the way."
The kwashiorkor children often have peeling skin or sores, swelling of the limbs or stomach and reddish hair, like Hamud Mohamed Abdi. The 2-year-old also weighs only half what he should for his age, but doctors say he is improving and might go home next week if he can get extra food every day. His parents are rail-thin themselves.
The weakest children can't even hold onto their mothers' breasts to get milk and are fed through tubes in their noses. The U.N. says it is the worst emergency in Somalia since the famine in the early 90s that triggered an international intervention that ended after two U.S. Blackhawk helicopters were shot down.
"This influx of severe cases we have not seen before," Abdi said.
Most have recently arrived in Kenya from Somalia, a war-ravaged nation which has not had a stable central government for more than 20 years. The refugees arrive on foot, or packed into dented minivans, praying that gunmen won't rob them or rape their daughters before they arrive at the overflowing camp, where nearly 400,000 people have sought refuge.
Among them was a couple who arrived at Amin's ward with twins. One had taken sick on the journey and was barely clinging to life. He slipped away in just a few hours. Amin said it made him want to cry for all day. From time to time he sees the parents, and he always makes a point of going to speak with them.
"The situation goes with you when you go home," he said. "I think that for every life we save in this hospital, there are so many more behind them we can't reach."
The U.N. has warned that routes out of Somalia are turning into 'roads of death' after parents were forced to leave dead children along the roadside. The ones who make it to Kenya but are too hungry, too sick or too weak to survive are buried in a small sandy graveyards near the hospital compound.
Most graves have no markers apart from thorny branches piled on top of the mounds. Plastic trash bags catch in the thorns, fluttering in the wind. The earth on many of them is fresh but the small sandy hills soon drift back into the ground. nearby children play football or fly small kites made from twigs and discarded plastic bags.
But most children survive with treatment, even those whose own parents have already let go.
"There was a child we treated last year _ Aden _ we had to treat him intensively for seven days. We didn't know if he would make it. His father and grandmother said, why are you taking him? He is already almost dead. Now he's walking around and his dad is talking about school," said Amin.
"Sometimes you are walking in the camp and someone calls you by your name and you don't recognize them, but they come up and thank you for helping their child."