Gado Badzere, Cameroon - Mikaila's mother fled with him and six other children when men with machetes and little bags of charms around their necks attacked their village outside Bangui, the capital of neighbouring Central African Republic (CAR).
Five months later, on a hot Tuesday afternoon in July, the three-year-old boy sat alone in one corner of a dimly lit tent. Only parts of his lean body were visible from under an oversized baseball shirt. His tangled hair had started to thin out around yellowish patches on his scalp.
The long flight through thick bushes left him with acute malnutrition, just like most of the other 13,000 residents of this camp for Central African refugees in eastern Cameroon.
Conditions here - and indeed at 300 similar sites along Cameroon's eastern border - have been slipping in the past months, say residents and relief workers. And inadequate funding is holding back badly needed emergency assistance.
Inadequate nutrition has sickened 30 to 40 percent of camp residents, most of them children and their mothers, says the UN fund for children (UNICEF). Rampant malaria and dysentery are the top causes of death. Water and sanitation services are dismal, at best. Local hospitals have seen consultations and hospitalisations jump seven to eight fold in recent months.
The relief organisation Medecins Sans Frontieres (MSF) has called for help, sent in more workers and erected temporary consultation and treatment areas to help hospitals cope with the growing numbers. This month, a UN official said more money was needed to "maintain momentum". "What happens when we have insufficient funds is that we make some very bad trade-offs," said Robert Piper, the UN regional humanitarian coordinator for the Sahel.
Most of these people have walked for weeks, months, in the bush.
Famished and dehydrated
More than 215,000 people have so far fled across the border into Cameroon, after a coup d'etat in March 2013 sparked an endless cycle of killings in CAR. The conflict there has since assumed religious undertones, pitting the mainly Muslim Seleka rebels against a Christian group named anti-Balaka. Both the African Union and France, the former colonial power, have sent troops to the country on peacekeeping missions.
About 106,000 refugees arrived in Cameroon this year alone. With tens of thousands still coming in every month, the UN refugee agency (UNHCR) says that number could reach 180,000 by the end of the year.
The vast majority, about 75 percent, are vulnerable women and children. Most of the men have either been killed in the conflict or fled in different directions, said those who managed to run to safety across the border.
Every new day and every new arrival of refugees bring new difficulties, said Rachel Marsden of MSF. Those crossing the border more recently arrive famished, dehydrated, and physically exhausted from their flight. "Most of these people have walked for weeks, months, in the bush," said Marsden.
Central Africans running away from the conflict often have to balance moving fast with staying alive. It often involves hiding during the day and trekking through thick forests at night, said a tribal chief at a camp in Garoua-Bulai, who identified himself only as Amadou.
"Refugees from CAR have lived through a nightmare with few equivalents," said Piper.
As numbers grow, nutritional, sanitation, health, education, and security needs are not being fully met because interventions have not been sufficiently scaled up.
In the meantime, some refugees are beginning to abandon the camps to fend for themselves among host communities, posing a threat to social stability. Others, especially young men and women, are seeking city life where they have already been associated with crime and prostitution.
"What can they do?" asked Amadou, pointing at their rundown dwellings - a cluster of handmade tents of sticks and waterproof sheets less than one kilometre from the CAR border. "There is nothing here."
No one, it appears, was ready for the scale of the humanitarian crisis, said Piper: not relief agencies, not donors, not the government of Cameroon.
In many places, refugees outnumber host populations by three to four times, worsening already precarious conditions in eastern and northern Cameroon where most Central African refugees are located.
"It obviously creates a huge strain," said Manuel Fontain, the West and Central African regional director of UNICEF.
The UN now believes more than 1.8 million people face food insecurity in parts of the country where refugees have flooded. Some 59,000 children are suffering from severe acute malnutrition and six million people are at risk of epidemics.
Just like hospitals, schools - which are insufficient in the region in the best of times - will soon be overrun. Competition for grazing fields has already begun.
... when you are dealing with 22,000 children who have gone through absolute hell, nothing could be more important than getting them back into some kind of normality and into some kind of daily routine in front of the teacher.
Local populations have sucked in the pressure and allowed refugees to stay in peace so far. But future tensions are inevitable, said Piper.
Even though it has been more than a year, the rest of the world has failed to pay serious attention to the humanitarian crisis caused by the massive influx of CAR refugees into eastern Cameroon, say relief organisations.
The World Food Programme says it may run out of food supplies by September. With the year half gone, UNICEF has only received about 15 percent of projected financial needs. UN agencies operating in Cameroon have jointly asked for $117m to support ongoing operations. But so far, they say they have only received $22m or 19 percent.
With the funding delayed, relief organisations fear they may soon have to scale back their operations or give up important services in order to concentrate on saving lives.
"Typically, education may be given second priority over food," said Piper.
“That is probably the right thing to do. But when you are dealing with 22,000 children who have gone through absolute hell, nothing could be more important than getting them back into some kind of normality and into some kind of daily routine in front of the teacher.
"There are obvious short term human impacts of lack of resources but there are some very sinister long term impacts, which is this terrible trade-off between what is important and what is urgent."
Big dreams amid despair
Despite the relentless slaughter that has bedevilled their country for 16 months - the atrocities they experienced as they fled and the dire camp conditions - the younger refugees have maintained their resolve to move forward.
Mikaila joins hundreds of other children in one of three "child-friendly zones" carved out at Gado Badzere refugee camp to learn new songs, rhymes and handicrafts every day. Through song and recitations, they advocate peace and talk of their dreams of becoming teachers, politicians and even presidents.
But, for now, relief organisations are not as optimistic.
Source: Al Jazeera