The choice loomed over Mohammed Fulait Ahmed, burdening him with shame.

His children were starving, and now his two youngest were sick — their tiny bodies burning with fever, their emaciated chests straining for breath. Mohammed’s pockets were empty and a trip to the hospital, three hours away, would cost more than he had made in months.

Desperate for help, he begged a local businessman to lend him money. The man agreed to loan him around $50 — only enough to help pay for one child’s travel to town. The other would have to stay behind.