In the Sahel, the months of June through October, when food stocks are depleted in anticipation of the next agricultural harvest and the rains bring mosquitoes and malaria in their wake, are a critical time for young children each year. During this period, which health workers in the region call "the peak", the public hospital in Madarounfa, located in southern Niger on the border with Nigeria, is in turmoil: tens of thousands of malnourished children are treated there. The trajectories of young Nigerien and Nigerien patients with life-threatening conditions and their mothers, whose daily lives are often marked by precariousness, escalating violence and banditry in northwestern Nigeria and the border areas, and the lack of access to pediatric care and other basic services, intersect there. Médecins Sans Frontières teams have been working in Madarounfa since 2005 alongside the Nigerien Ministry of Health and opened a new nutrition program in Katsina on the Nigerian side in 2021. While progress has been made in Niger and the region to combat malnutrition, it continues to be a "gateway disease" for too many children and long-term investments are needed to improve its prevention.