A/HRC/19/73 malnutrition has been recognized by other donors and agencies, such as the European Union and the World Food Programme.53 28. Fighting malnutrition and associated childhood diseases requires accountability and that is precisely what the human rights obligations of States establish. They establish an integrated accountability framework, whereby States with high numbers of malnourished children are accountable for actively removing discrimination patterns (against women, the poor living in the rural areas, etc.; see A/HRC/16/40), promoting participation and inclusiveness of the most vulnerable and, importantly, systematically eradicating corruption and promoting transparency. The human rights framework also requires that the international assistance of wealthier States enables individuals to feed themselves and does not only bring short-term alleviation while stifling the prospects of sustainable agriculture practices.54 Moreover, coherence – as opposed to fragmentation – of international law should be sought by all States, and trade and investment regimes should thus not be allowed to collude with the human rights system: especially when at stake is the nutritious food so much needed by malnourished children or the antiretroviral medicine for their HIV infected mothers is at stake. 29. In conclusion, as emphasized by the Special Rapporteur on the right to food in his most recent report (A/HRC/19/59), “a transition towards sustainable diets will succeed only by supporting diverse farming systems that ensure that adequate diets are accessible to all, that simultaneously support the livelihoods of poor farmers and that are ecologically sustainable.” Nutrition initiatives should therefore be based upon a human rights approach, defined through accountability, participation and non-discrimination. III. Children at risk of or affected by noma 30. The first part of this study has underlined the importance of understanding the intersection of malnutrition, childhood diseases and human rights. Noma is the most brutal face of poverty and malnutrition in children and thus gives rise to some of the worst violations of the rights of the child. 31. Noma (cancrum oris), which borrows its name from the Greek term “to devour”, is an infectious yet non-contagious disease that destroys the soft and hard tissue of the face. 55 The lesion is thought to begin as a localized ulceration in the gingiva or the mucosa of the cheek or lip and to spread rapidly through the surrounding tissues. At the same time, there is swelling of the corresponding part of the face. Untreated, the swollen skin will become gangrenous and will perforate, within a week, leaving a hole in the face.56 Noma is thought to lead to death in 70–90 per cent of cases.57 Most deaths are attributed to complications such as pneumonia, diarrhoea and septicaemia associated with severe malnutrition. 58 53 54 55 56 57 58 See Center for Economic and Policy Research, “France Increases Local Rice Procurement for Food Aid; Will the US Follow Suit?”, 18 July 2011; World Food Programme, “WFP Launches Strategy to Bring Social Security and Stability to Haiti”, 30 March 2010; French Embassy in Port-au-Prince, “De la fourche à fourchette (suite)”. See A/HRC/19/59/Add.5. C.O. Enwonwu et al., “Noma (cancrum oris): Seminar”, The Lancet, vol. 386 (2006), p. 147; D. Baratti-Mayer et al., “Noma: an „infectious‟ disease of unknown aetiology”, The Lancet Infectious Diseases, vol. 3, No. 7, July 2003, p. 419. Ibid.; K. Bos, K. Marck, The Surgical Treatment of Noma (Alphen aan den Rijn, Belvedere/Medidac, 2006), pp. 13–14. M. Tsechkovski, “A disease such as Noma should not exist”, Noma Contact, October 1997, p. 1. D.E. Barmes et al., “The need for action against oro-facial gangrene (noma)”, Tropical Medicine and 11