Nevertheless, it can be hard for charities and the government to focus attention or funds on chronic malnutrition when the country is battling a more dramatic type of hunger, which is also easier to address: acute malnutrition.
In clinics nationwide, thousands of babies and toddlers have experienced such severe shortages of calories that they have the protruding bones and distended stomachs familiar from photographs of famine victims.
Acute malnutrition affects more than one in four children in some areas, but it can usually be resolved relatively quickly with a steady supply of high energy Plumpy’nut feeding paste.
In some ways, chronic malnutrition is harder to tackle as the children suffering from it often do not show their desperate need for help.
“You might see a child who appears underweight, or short for their age, but it doesn’t really tell you much unless you line them up against a well-nourished child. But it prevents them growing up to lead a more productive life,” Morrison said.
However, appearances are disastrously deceptive. A lack of iron, which affects three-quarters of Afghan children, reduces activity and productivity. In young children, it disrupts brain development with effects that include “stunting, sickliness, poor school attendance and lower levels of concentration and memory.”
A lack of iodine “is the world’s leading cause of preventable mental impairment,” and a lack of vitamin A hobbles the immune system, pushing up death rates among children under five.
So severe is the damage that tackling it by lacing basic foods such as salt and flour with micronutrients has been rated one of the most economical ways to do good.
“In the worst-affected countries, the benefits of supplementation with vitamin A and zinc can be up to 100 times higher than the costs,” according to a research paper on the impact of giving children “micronutrients” — generally known in the West as “vitamins and minerals.”
Recently, the Afghan government launched a five-year program to fortify flour used to make ubiquitous nan flat bread — often the only daily food for poor families — oil and other foodstuffs. Gradual progress with women’s education, healthcare and hygiene education is expected to bring slow but important progress.
A recent World Bank study found a direct link between sanitation and height: a five-year-old child in a community where everyone uses a toilet is on average more than 2cm taller than a child from one where people defecate in the open.
Poverty is also a pressing problem, in a country where a third of all citizens do not always know where their next meal will come from. A recent UN study found even a minimally healthy diet was beyond the reach of the majority of Afghans. In some provinces, only one in five could afford balanced meals.
While the Afghan government and aid workers try to address problems that could take years to solve, healthworkers are often hobbled by a focus on more apparently pressing problems.
“We do worry about chronic malnutrition, but all we can give them is advice,” said Nehmatullah Majidzafa, a nutrition nurse at an Oxfam-supported project in the shadow of the ruined ancient city of Balkh, where most funds support feeding the children in most obvious need.