ZAM ZAM, Sudan
The boy's legs were limp. Folds of skin hung loosely from his bones, easily holding the shape of the doctor's pinch - a telltale sign of dehydration. His face glowed with fever and his milky eyes darted desperately around the dim tent. He was a month old, but weighed less than five pounds.
If Mukhtar Ahmed could be said to have any good fortune in his short life, it is that he fell ill last week, and not a month from now. Within a few weeks, even the doctor treating him may be gone.
Sayid Obeid Bakhiet's clinic, one of just two left in this vast, squalid camp of 35,000 people displaced by the conflict in Darfur, is out of money and will be forced to close at the end of June unless the organization that runs it, the Sudanese Red Crescent, finds more cash.
"What will happen to these people when I am gone?" he asked as he rushed between the flood of patients he sees - as many as 80 a day, six days a week. "Only God knows."
The war in Darfur has set off what the United Nations has called the "world's worst humanitarian crisis," a crucible of death that seems to grow grimmer despite a new peace agreement.
But it is not bullets that kill most people here now. It is pneumonia borne on desert dust, diarrhea caused by dirty water, malaria carried by mosquitoes to straw huts with no nets. At least 200,000 and perhaps as many as 450,000 people have died in Darfur, according to estimates by international health and human rights organizations, though no one is sure how many of the deaths have come from combat, or from hunger and disease. These days, people mostly die because they cannot get health care, clean water or enough food.
Local and international organizations here are trying to stave off these killers, but their ranks are shrinking. They take care of 2.5 million people driven from their homes and farms with an ever diminishing pool of money as donors, particularly in Europe, Asia and the Middle East, have largely ignored Darfur. Beyond that, they work under tight restrictions imposed by Sudanese officials, and face attacks by militants who hijack their vehicles and menace their workers.
The conditions are so dire that the effort faces collapse, Jan Egeland, the top United Nations aid official, told the Security Council last week.
The new peace agreement seeks to end the brutal war in Darfur, in which rebels seeking autonomy and wealth for this region have fought against the government and its allied Arab militias. But the accord will not end the catastrophe anytime soon.
In Zam Zam, a health center run by Doctors Without Borders closed earlier this month, and no other organization has stepped in to fill the gap.
The Spanish Red Cross, the organization coordinating the handful of remaining charities working in this camp, is frantically trying to find more money to keep Bakhiet's clinic going, and is optimistic that a donor will be found.
It is negotiating with one organization that has tentatively agreed to support the clinic. But that organization, like so many here, faces a shrinking pool of donations as well, and has not yet committed the money, aid officials here said.
In the meantime, the Sudanese Red Crescent clinic is limping along. It runs on a skeleton crew of Bakheit, two nurses, a midwife, a pharmacist and a lab technician.
Bakhiet knew immediately that Mukhtar needed urgent attention. A fire of panic burning in her eyes, his mother, Mariam Ahmed, urgently pressed the tiny child into the doctor's arms. "He vomits everything," she said. "It looks like he cannot breathe."
Bakhiet listened to the boy's laboring chest and shook his head. "Pneumonia," he said. He felt the soft spot on top of Mukhtar's still-forming skull. It was sunken. "Dehydration," he added.
Mukhtar needed an intravenous drip immediately to rehydrate him and bring down the fever, and a steady flow of antibiotics. Then he needed a hospital where he could receive care around the clock. Bakhiet and his team would shut down at 2 p.m. "If he stays in the camp with no medical attention he will die," Bakheit said. "Within a few hours he will start having convulsions."
There is no ambulance service here, so patients referred to the hospital in El Fasher, 15 kilometers, or 10 miles, away, take local buses. At more than a dollar each way, the fare is out of reach for most. As a nurse guided a needle into Mukhtar's minuscule hand, his mother dispatched a relative to see if anyone could help her pay the fare.
From an aid perspective, things had been getting better in Darfur, until recently. "In 2005, we made a lot of gains in terms of child mortality, in terms of reducing malnutrition," Egeland said in an interview. "But now we are seeing those gains rolled back."
In fact, Doctors Without Borders made plans to close its Zam Zam clinic because residents had been doing better. Key indicators like mortality and malnutrition rates had improved to the point that the situation no longer constituted an emergency as the organization defined it.
Since Doctors Without Borders specializes in such emergencies, it decided to deploy elsewhere, officials with the organization said. They searched for but did not find a replacement to take over in Zam Zam camp.
Then last month, Unicef said that child malnutrition in Darfur was creeping back up toward the level it reached in 2004, when the crisis was at its worst. The World Food Program announced this month that it would halve rations for Darfur because it had received just 32 percent of the $746 million it needs to feed the region.
The crisis has been softened somewhat by the Sudanese government, which released 20,000 tons of grain for Darfur from its strategic reserves.
In Zam Zam, Mukhtar's mother was having trouble finding the money to go to El Fasher, and Bakhiet grew nervous. He had lost one little boy 10 days earlier to a deadly combination of disease just like Mukhtar's, and could not bear to see it happen again. Mukhtar had his second stroke of good luck - an African Union team visiting the camp agreed to take him and his mother to El Fasher, where Mukhtar was admitted to the hospital.
The emergency room doctor in El Fasher who examined Mukhtar was guardedly optimistic about the boy's prognosis. He uttered the Arabic phrase that is invoked endlessly in this merciless place: "Inshallah," God willing.
"Inshallah, he will live," the doctor said.