The young girl smiling and running towards the camera is almost unrecognisable. Four months ago, five-year-old Ekure Nachukuli was so hungry she could barely muster the strength to walk. In July, her family in Turkana, northern Kenya, was in the grip of a prolonged drought which pushed almost 13 million people to the point of starvation across the Horn of Africa. She was pictured on the front page of this newspaper, weakened by hunger and slumped over a bag of food aid. Now, her cheeks – once sunken by hunger – are plump; her arms and legs, formerly brittle as twigs, are strong.
The Independent on Sunday watched the beginning of this transformation last July as Ekure was weighed, measured and put on an emergency feeding programme by the medical relief charity Merlin, which we have chosen for this year's Christmas appeal.
The charity is one of very few working in this inhospitable 35,000sq km district, whose population of 37,000 has been suffering largely unnoticed, far from roads or any help.
Ekure's family, who lost most of their livestock, had survived on bitter wild berries which had left the child so weak she weighed less than many British two-year-olds. Her medical records even say she is two, but Merlin believes she is actually five and her records were created late. Her mother, Etokoit Nachukuli, herself rake thin, had looked on frowning with fear as a nurse classified Ekure – the youngest of her eight children – as severely malnourished.
"We thought Ekure would be swept away by the drought," Etokoit said, speaking last week at their remote home in Nakapelewoi, half a day's drive from the regional capital, Lodwar. Ekure was given bags of the fortified food PlumpyNut, which the young girl recalls shyly as being ebob – meaning "sweet" in Turkana – and refers to as chocolate. "Ekure liked that chocolate, because she was hungry and malnourished," her mother recalled. "She ate it, and that's what she ate until she became healthy again... She changed, she got fatter; that's why she's healthy the way she is now. She was bad before, weak – I had to carry her on my back."
In the past, the Nachukuli family had a herd of 1,000 goats, but this has been reduced to about 10. They also lost all their donkeys and share only a handful of camels with their extended family. The Kenyan government estimates that some 248,000 livestock were lost across the country this year because of the drought. More than 3.5 million Kenyans are still reliant on food aid for survival.
Now the family's camels are producing milk again, giving them enough to drink and some left over to sell, providing cash to buy flour.
Eugenie Reidy, an anthropologist working with the Turkana people, found Ekure and her family living only two kilometres (just over a mile) from the clearing where Merlin first distributed emergency food in the summer. She said this unseasonably long drought – which has gone on almost uninterrupted by rain for three years – has disrupted all their normal mechanisms of survival. "The pattern is broken. When you know when the rains are coming, and when the drought is coming, you know what to expect and how to adapt. What's made it hard for families such as Ekure's is that it's become so hard to predict things."
Etokoit said: "It used to be drought followed by good season, but now the drought continues and continues. At last, we have received the rain; that's the good season."
The long-awaited rains began last month and, like Ekure, Turkana itself is transformed. Where once the earth was cracked and dry, leaving nothing to grow but thorn bushes and dying acacia trees, now the landscape is verdant green, with grass, flowers and trees poking up through wet soil.
But in a cruel twist, the rains that have been so long hoped for are now wreaking havoc for many people. Showers are normal between October and December, but the past month has been an almost uninterrupted deluge, causing flash floods that send raging rivers across roads, cutting off communities from urgently needed food supplies. The rain has also brought new health problems, with outbreaks of cholera and typhoid.
Lea Gilbert, Merlin's programme director in Turkana, said: "The rains are really becoming a problem. It's jumped from one challenge to another: first there was not enough water and now there's too much."
There are some improvements, however. Food prices have been decreasing – a bag of maize now costs 40 per cent less than at the height of the crisis – making food more affordable for those who have lost their herd. Malnutrition rates are slowly decreasing too. In May, the proportion of the region's under-fives who were acutely malnourished was 37 per cent, now it is between 24 and 28 per cent.
At Lodwar's stabilisation centre, the worst of the crisis seems to have passed. Maureen Chepwony, a nurse, is treating only a handful of emaciated children on her ward – an improvement on the full beds earlier. "We still get serious cases of malnutrition but the number of patients has been going down; this month we've had 18 patients. In August it was 35."
For some in Turkana, the past month has been worse than any other, however. With so much grazing land now available, striving to regain a herd has become increasingly violent. In Elelea, armed warriors from the rival Pokot tribe have stormed villages, stealing herds and shooting dead anyone who defended them.
Esther Egal fled her home village in Elelea with her eight children after the Pokot arrived. Her husband, Lokutoni, was out herding their cattle when he was shot dead by the armed raiders. "They shot him and took all his animals. They took cows, donkeys and goats and chased us off the land. We have nothing now," she said.
Esther picked up her children and ran with them for 40 kilometres, until she reached Kerio, to stay with a cousin. Her three youngest children are now queuing with her for a health check at Kerio stabilisation centre, where Merlin staff screen children for malnutrition. The youngest, Loipodi, is measured first. His arm circumference – a test for starvation – is tiny, and the measuring band puts him firmly in the red zone and in need of urgent help. The next eldest, Losike, is also in the danger zone and has to hold on to his shorts to stop them falling from his tiny waist.
Loipodi's case is the most acute, and he is given a sachet of PlumpyNut to test his appetite. He sucks at it hungrily, finishing every last drop. Esther smiles with relief as she prepares to leave with a two-week supply of PlumpyNut and enriched flour. "Now all my children can eat. I think we'll be all right now."
Esther is more fortunate than the majority of the villagers who survived the attack. Most fled to Louwae, another 40 kilometres away from Kerio. Their makeshift camp there has been in the grip of a measles outbreak. At least 11 in the community are known to have died since October and 40 per cent of the children are acutely or severely malnourished.
Two weeks ago, Merlin and the Kenyan Ministry of Health managed to reach them with food and medical supplies, setting up a mobile clinic to treat the ill. But since the heavier rains came, Louwae has been shut off from help by a vast, rapid river that rushes across a dip in the dirt road. Until the river becomes passable, the supply of food and medical help will cease.
Philip Ewoton, a nutrition officer who arrived at Kerio clinic to run the feeding programme, said: "It will be a very long weekend for people at the camp. Things will deteriorate now because the chain has been cut. The change in the weather makes it tougher, too, because they are sleeping outside and it's cold."
Merlin is lobbying local government and other aid agencies to find a lasting solution for herders to keep their livelihoods. In the meantime, the delivery of aid has prevented Turkana's crisis from becoming a catastrophe.
To make a donation visit: www.merlin.org.uk/independent-on-sunday-appeal or call 0800 035 6035 (24 hour, seven days a week - donation line).