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 Noma
(cancrum oris) is an acute and ravaging gangrenous infection affecting
the face. The victims of Noma are mainly young children caught
in a vicious circle of extreme poverty and chronic malnutrition.
Noma begins
with ulcers in the mouth. If the condition is detected in the
early stage, progression can be prevented with the use of common
antibiotics and immediate nutritional rehabilitation. If left
untreated, as happens in most cases, the ulcers progress to Noma
at an alarming pace. The next stage is extremely painful when
the cheeks or lips begin to swell and the victim's general condition
deteriorates. Within a few days, the swelling increases and a
blackish furrow appears and the gangrenous process sets in and,
after the scab falls away and a gaping hole is left in the face.
It is estimated that the mortality rate reaches up to an alarming
90%.
 Survivors,
those whose pitiful faces can be seen on these pages, can arguably
be described as the fortunate ones. However, their lives will
never be the same and they will suffer three main afflictions
- facial disfigurement, functional impairment and social outcast.
The scar tissue
restricts jaw movement and a child who survives is unlikely ever
to be able to speak or eat normally again. In infancy, some children
lose their lips and soon die of starvation, as they are unable
to breast-feed.
The World Health Organisation (WHO) estimates that 140,000 new cases of noma occur each year and of these, a mere 10% survive. That means that 126,000 die each year, mainly in sub-Saharan countries from Senegal to Ethiopia, a region known as "the noma belt".
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