Less than one half of one percent of Djibouti's desert landscape is adequate for farming. As a result, almost all of the country's food is imported, adding to the already high cost of securing a nutritious meal. Less than one half of one percent of Djibouti's desert landscape is adequate for farming. As a result, almost all of the country's food is imported, adding to the already high cost of securing a nutritious meal. With little land to farm and not much industry, most Djiboutians struggle to make a living. Nearly two thirds of the country's population crowds into the sprawling capital city whose rapid and unplanned expansion has put a strain on limited resources and inadequate infrastructure.

Those forced to live in these urban shantytowns are mainly unregistered migrants, asylum seekers and poverty stricken Djiboutians who have fled drought ridden rural areas. The prevalence of global acute malnutrition at the national level is estimated at 27.5 percent including 7.1 percent for severe acute malnutrition, some of the highest rates of endemic malnutrition in the world. At MSF's clinic in the Balabala district of Djibouti, doctors and nurses scramble to treat a never-ending influx of young malnourished patients. Last year, the clinic treated nearly 1,730 malnourished children under five years old. In this multimedia reportage shot by photojournalist Marcus Bleasdale, hear clinic workers speak about the successes and frustrations of their work.