© Reuters
Children eat in a makeshift house in an Afghan refugee camp
About a third of young children in southern Afghanistan are acutely malnourished, with a level of deprivation similar to that found in famine zones, a government survey has found, despite the hundreds of millions of dollars in foreign aid that has been poured into the region.

The worst affected area identified by the United Nations-backed survey was the southern region, centred around Kandahar and Helmand. The report found about a million Afghans under five were acutely malnourished.

''What's shocking is that this is really very high by global standards,'' said Michael Keating, the deputy head of the UN mission in Afghanistan. ''This is the kind of malnutrition you associate with Africa and some of the most deprived parts of the world, not with an area that has received so much international attention and assistance.''

The Afghanistan Multiple Indicator Cluster Survey found 29.5 per cent of children are suffering from acute malnutrition. A level of more than 30 per cent among young children is considered a sign of a famine, although under UN guidelines, child malnutrition is just one of several criteria used to decide if an area is suffering a famine.

Southern Afghanistan has adequate food supplies, experts say, but a serious problem with nutrition. Some families are too poor to buy supplies while others have little education about how to nourish their children; common illnesses like diarrhoea also sap children's strength.

A major problem is attitudes to breast feeding, according to a UN nutrition specialist, Elham Monsef. Women are often told breast milk is not good enough or find it hard to nurse, so infants are given everything from tea and water to formula milk that is over-diluted or made with dirty water.

Basic health measures common in most developing countries, such as enriching flour and putting iodine in salt to ensure healthy brain development, are not universal in Afghanistan.

On a paediatric ward at Mirwais hospital in Kandahar city, children admitted for therapeutic feeding were visibly wasted, with saggy skin, protruding bones and no energy; at least one had the disease kwashiorkor, caused by lack of protein.

On a recent visit, the hospital was packed with desperate mothers such as Fatima, who had travelled from the violent Helmand district of Sangin to seek help for her 18-month-old son, Saddam. At 4.4 kilograms, he weighed the same as some newborns in Britain, and lay listlessly on a greying bedsheet he shared with another patient, his older sister and three women.

Poverty has left Fatima helpless in the face of her son's suffering. ''I cannot produce mother's milk, but we are not able to buy food or powdered milk. My youngest child died from this.''

Aid workers admit that evidence of an extreme crisis caught them by surprise. ''The numbers are just too serious to ignore,'' said Aidan O'Leary, the head of the UN office that co-ordinates the humanitarian response to crises in Afghanistan. ''It's very clear that the nutrition response as a whole has to be ramped up.'

The last such survey was conducted in 2004 and although the conflict has since escalated, there has also been an increase in aid. USAID has poured hundreds of millions of dollars into southern Afghanistan. Britain earmarked tens of millions more for development work in Helmand.

The UN and aid groups are racing to gather more details on the scale of the problem.

In a sign of how severe the problem is, experts warn the crowded wards tackling malnutrition in provincial centres help only a tiny portion of families affected. ''Our focus is on the acute cases, but we need to do more community outreach to prevent it,'' said Vidhya Ganesh, the deputy head of Unicef in Afghanistan. ''The major challenge for us is that therapeutic feeding [in hospital] presents only the tip of the problem.''