ZINDER : Mourdja’s nose has been eaten away, like one lip and part of her upper gum, leaving the 13-year-old girl atrociously disfigured by noma, a disease that thrives on malnutrition. “It was better before,” the teenager says shyly and simply in the arid heartland of Niger, one of the world’s poorest nations, clearly ill at ease and fiddling with her bracelets.

Mourdja can no longer look people in the eye, her face ravaged by the polymicrobial infection, which began by making her inflamed gums bleed. Just three days later, rapid tissue damage stole her beauty — along with her childhood. “The problem is that this is a very fast-acting disease,” says nurse Fati Badamasi, who works for the Swiss NGO Sentinelles, active in Niger since 1992. “The necrosis takes hold in 72 hours. If the patient comes to us with a blackish patch (on the face) it’s already too late.”

Ali Adah, who oversees the charity’s work in the country on the southern edge of the Sahara, speaks of the fearful stench of noma, which “smells of decay, like a corpse”. “When I come to the office and we have a new case, I smell it straight away,” he says. Mourdja’s flesh gave off that odour after she caught the infection sometimes called oro-facial gangrene, which can break out where food is short and lacks key vitamins and water is polluted.

Noma also strikes when natural immunity is at its lowest. The teenager comes from a “very poor” family in the central Tahoua province, according to Aboubakar Moussa Mato, a social worker with Sentinelles. She lives with her parents and “about 10 brothers and sisters” in a straw hut “with no water or electricity”. “Noma is caused by malnutrition and a lack of hygiene,” nurse Badamasi says. “It is a disease born of poverty. Well, in Niger there is plenty of poverty.” Niger is prone to food crises and holds the lowest place on the comprehensive Human Development Index drawn up each year by the United Nations Development Programme.