The man who choses who should live and who will die. Alomata, Ethiopia 1985

On most mornings there were about 500 huddled in eight lines outside the centre. At the camp in Alomata a feeding programme and clinic were run by the evangelical agency World Vision. The relief workers were determined that the centre should not grow into a camp and insisted that people returned home after they had received their allocation of food. Only those children in need of intensive feeding were admitted to overnight care.

They had struggled in, those who had been able to make journeys which often involved several days walk, and were now waiting for the arrival of Dr Hector Jalipa, a physician from the Philippines employed by World Vision. His task was to inspect each one and decide whom to admit. Some days he had as few as 16 places to offer.

The day I joined him it took him two hours to progress through the waiting lines, which was just the prelude to his day’s work. He pulled at the skin on the scrawny forearms of the children; on those he deemed most needy the skin fell back like wrinkled crepe paper, all its natural elasticity gone. He turned the worst to inspect their buttocks; where the skin hung down in folds, which he called “its baggy pants”, it showed that the child’s body had exhausted all reserves of fat and had begun to live off the muscle. Dr Jalipa carried a small pad of scrap paper. On it he scribbled the name of the section the child should be admitted to: feeding or supplementary feeding, intensive or super-intensive wards, or simply the clinic where the problem was purely medical.

The anxious parents knew the value of these little scraps of paper, passports as they were to the border between life and death.

“He has no mother, he has no mother,” repeated a wild-eyed father, running behind the doctor, holding out his child who had earlier been passed over as insufficiently malnourished. The man was pushed away by the camp guards.

“He looks ill,” I ventured.

“He is, but others are more ill,” said Dr Jalipa.

The next boy was particularly thin, but the doctor spotted that beneath the ragged cloak which covered his arm was a little pink bracelet.  The guards conducted a heated conversation in Amharic with the woman.

“Cut it off,” the doctor said, and moved on down the line. “The bracelet means that the child was already in our feeding programme but his mother has sold his ration card in the market and was trying to get him re-admitted to get another one. So I have thrown him out,” he explained.

For the woman it was a costly gamble to have lost. “Yes, but she has to be taught a lesson or they would all do it, sell the ration card to buy coffee or some other thing in the market.  In a few days she will re-apply and we shall have forgotten all about it and re-admit her.”

Dr Jalipa’s daily round seemed a microcosm of the depressing enormity of the whole relief effort. There was something terribly arbitrary about who would reach him and who would not, whom he would chose and whom he would pass over, who would live and who would die. He was forced daily into making terrible decisions, and yet the wave of humanity continued to pour into his camp, making a mockery of what little he was able to do. I was seized with the conviction that his presence was utterly pointless.

Because the doctor professed himself a Christian I asked the question I had not found the courage to ask at Korem. How could he make these decisions, on whom to admit and whom to exclude? Was there not an awful sense of taking on a function which properly belonged only to God?  “It is because I am a Christian that I can do it. We choose the weakest and feed them because we do not want anyone to die and they are the most vulnerable. To a Christian every human life is sacred. A non-Christian might make a different judgement: we do not have enough resources to go around here so why waste them on children who are probably going to die anyway? why not give the food to those who have the best chance of surviving?  That, as I understand it is a common attitude in Africa and one that Ethiopian culture seems to share: if a woman here has two children, one weak and one strong, she will feed the strong one first. In war doctors do something similar; it is called triage. But that does not seem to me to be a Christian approach.”

Such an approach produced the hapless situation where the doctor had to pass over a child today on the grounds that he was insufficiently malnourished to warrant treatment; tomorrow when the child had become ill he would be fed. “Yes it is crazy; it means we feed them back to health and then release them. A few weeks later they are back because their families cannot feed them and the official rations arrive only sporadically.” There seemed no sensible response and my gloom deepened the more.

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