MOPTI, Mali (Thomson Reuters Foundation) - Cradling her baby in a health clinic in central Mali, Mariama Tieminta clutched him to her breast as she recalled the moment jihadists stormed her village, firing their guns into the air.

Malnourished children wait to be seen with their mothers in a health clinic in Mopti, Mali, 18 May, 2017. Thomson Reuters Foundation/Kieran Guilbert

“When I heard the gunfire, I couldn’t think of anything but dying,” said Tieminta, who fled with her four children to the city of Mopti, where her husband was working as a tourist guide.

Five years on, the specter of death is looming once more.

Her two-year-old son is malnourished amid a deepening food crisis in the West African nation, while violence, which erupted in the north in 2012 when Islamists hijacked an ethnic Tuareg uprising, is spreading south and intensifying in the center.

“Every time I hear about an attack nearby, or that the jihadists are moving closer, I think we could be next,” Tieminta told the Thomson Reuters Foundation in Mopti’s Komoguel clinic.

The growing Islamist threat in central Mali has hit farming and shut down hundreds of schools, while a nationwide state of emergency restricts movement - hindering aid delivery and making it harder for people to access services like healthcare.

With aid agencies already stretched thin across the lawless north, many say they are struggling to respond in the center of the country - a region increasingly outside state control.

At least 3.8 million people across Mali will need food aid this year, up from 2.5 million in 2016, according to the U.N. Office for the Coordination of Humanitarian Affairs (OCHA).

More than half of those in need are children. In central Mali, a lack of food, the closure of schools by militants and inadequate social services mean the youngest are hit hardest by the violence, and may even be drawn into it, humanitarians say.

“Children are at risk of being recruited if they are not at school,” said Ute Kollies, head of OCHA in Mali.

“Youth groups say there are only a few options if you want to make money - become a criminal, a trafficker, a rebel or a jihadist fighter. Otherwise, you may become a victim, they say.”

“SHUT DOWN OR DIE”

Despite a 2013 French-led operation to drive the separatist Tuareg rebels and Islamist militants out of key northern cities they seized in 2012, a U.N. peacekeeping mission and years of peace talks, Mali remains beset by unrest and ethnic strife.

A recent surge in attacks by Islamists in the north and center prompted the government in April to extend by six months a state of emergency first imposed in November 2015.

But the heightened vigilance has hampered aid provision.

A ban on motorcycle travel has also led to fewer people visiting health centers or receiving care in central parts of Mali which are home to some one million people, aid groups say.

“Humanitarians will always adapt and find solutions, but we can’t take health centers with us – so people in central Mali may continue to struggle to receive care,” said OCHA’s Kollies.

The rising Islamist influence in regions like Mopti, fueled partly by jihadist recruitment among the marginalized Fulani, who are fighting Mali’s largest ethnic group, the Bambaras, has also forced hundreds of schools to close since 2016.

In Mopti alone, some 270 schools have shut - double the number a year ago - leaving 80,000 pupils in the region without education, according to the United Nations.

Islamist militants are targeting schools at a startling rate, education experts say.

“The jihadists are going after all the French schools, those seen as western, and threatening the teachers to shut down or face death,” said Amadou Midou of Save the Children.

“Teachers are fleeing, spreading the message, and more and more schools are closing down.”

LAWLESSNESS LOOMING

At the Komoguel clinic, a dozen mothers huddled together on benches with their malnourished children, wait to be seen.

Listless, the infants barely stirred as the nurse wrapped a tape measure around their skeletal arms.

“Too many mothers don’t recognize the signs of malnutrition, and it means they are bringing their children here later than they should be,” said nurse Christine Dakouo, gently coaxing a baby into eating from a packet of nutritious peanut-based paste.

Around 142,000 children under five are expected to suffer severe malnutrition across Mali this year; in Mopti, at least one in 10 are malnourished, according to OCHA.

Poverty, insecurity and a lack of food are fuelling a ‘vicious cycle’ of malnutrition in Mopti, health workers say.

“I can’t help but get frustrated when children come back here malnourished for a third or fourth time,” Dakouo added.

While people like Dakouo struggle with limited funds and supplies, humanitarians fear spiraling violence will drive teachers and doctors out of central Mali, leaving aid agencies to run basic services, as is the case in the north.

The havoc wrought by Islamist jihadists is being compounded by inter-communal clashes, which are growing in the absence of state officials and law enforcement, security analysts say.

More than 117 people have been killed by such violence in the central regions of Segou and Mopti since last year, according to the International Federation for Human Rights.

“One of the main challenges we face is the displacement of local authorities, teachers and social service providers ... this has had a substantial impact on the availability of basic services,” said Kadiatou Diallo of UNICEF’s Mopti office.

For many mothers in Mopti like Tieminta, such services are a lifeline as they struggle to keep their children fed, schooled and healthy.

“I don’t know what will happen, but it’s hard to live easily without peace,” Tieminta said. “All I know is that I am scared.”