A/HRC/19/73 complexity of the impact that HIV/AIDS and malnutrition have on each other”.29 A typical example of this complex relationship between HIV/AIDS and malnutrition is the need to balance the risk of infants acquiring HIV through breast milk with the higher risk among non-breastfed infants, in particular from the developing world, of dying from malnutrition and diarrhoea.30 15. Another facet of the relationship between severe malnutrition and childhood diseases is the medical complications ensuing from specific aspects or pathogens occurring in malnourished children. Malnutrition compromises the immune system, which acts as a trigger for severe diseases with unclear aetiology and wounds in kwashiorkor.31 Examples of such diseases include Lyell‟s syndrome in severely malnourished children, noninfectious wounds in children with severe malnutrition, myelodysplastic syndromes and noma. The second part of this study will focus extensively on noma. 16. Infants and young children are the most vulnerable to malnutrition because of their high nutritional requirements for growth and cognitive development and their often vulnerable place in society.32 Malnutrition as a stand-alone condition and in relation to other childhood diseases – be they chronic, acute or severe complications – contributes significantly to the premature death of children. In fact, malnutrition is thought to contribute to one third of the 8 million deaths of children under 5 every year.33 17. It is widely acknowledged that the socioeconomic conditions into which children are born and in which they grow up and live influence their opportunity to be healthy: the lower an individual‟s socioeconomic position, the higher their risk of poor health; which applies from country to country, as well as within countries.34 Poverty is a complex human condition characterized by “sustained or chronic deprivation of the resources, capabilities, choices, security and power necessary for the enjoyment of an adequate standard of living and other civil, economic, cultural, political and social rights” (statement by the Committee on Economic, Social and Cultural Rights, E/C.12/2001/10, para. 8). The Special Rapporteur on extreme poverty and human rights defines the “realities of poverty” as stigmatization, discrimination, penalization, and exclusion (report to the General Assembly, A/66/265, para. 5). In slums and rural areas that have been affected by disinvestment in agriculture in recent decades (see study of the Advisory Committee on discrimination in the context of the right to food, A/HRC/16/40, paras. 18 and 21), poverty and its realities are often responsible for the ignorance of and/or lack of options for parents in respect to food and feeding practices, hygiene and sanitation, healthy child-rearing and child education, and the abyss of child labour and prostitution. The elimination of poverty is an imperative flowing from the human rights obligations of States to realize all human rights for all, while prioritizing the most vulnerable (see chap. II, sect. B.). 29 30 31 32 33 34 WHO, “Nutrition and HIV/AIDS”. Available from www.who.int/nutrition/topics/hivaids/en/index.html. See WHO, Joint United Nations Programme on HIV/AIDS (UNAIDS), United Nations Population Fund (UNFPA), UNICEF, Guidelines on HIV and Infant Feeding 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence (Geneva, 2010). Communication with Dr. M-C. Bottineau; MSF, A Beginner’s Guide to Malnutrition, www.msf.or.jp/info/pressreport/pdf/pressMalnutritionE.pdf. M. Blössner, M. de Onis, Malnutrition: quantifying the health impact at national and local levels, Environmental Burden of Disease Series, No. 12 (Geneva, 2005), p. 3. See J.K. Rajaratnam et al., “Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4”, The Lancet, vol. 375, No. 9730, 5 June 2010, pp. 1988–2008; R.E. Black, “Global, regional, and national causes of child mortality in 2008: a systematic analysis”, The Lancet, vol. 375, No, 9730, 5 June 2010, pp. 1969–1987; www.starvedforattention.org. World Conference on Social Determinants of Health, Rio de Janeiro, 19–21 October 2011. 7