(CNN)In a single week, eight of Rob Freishtat's tiny patients died of hunger.
In his photos, the children already seem to be vanishing, dwarfed by diapers three times their girth and the thick gloved hands of medical staff. Small comforts on their hospital beds, like the rolls of baby blankets printed with cheerful ducklings make them look even tinier.
All were under 2 years old when they died.
"Over the years, I've seen plenty of kids in Haiti with malnutrition get sick with infections or something else and die. Sad but not unusual. This is the first time that I have seen them literally starve to death," Freishtat told CNN after returning from a week at Sacre Coeur private hospital in the northern Haitian city of Milot, in early December.
Freishtat is the chief of emergency medicine at Children's National Hospital in Washington, DC, and he has volunteered his pediatric skills in Haiti every year for the past decade, ever since a devastating earthquake hit the Caribbean nation on January 12, 2010.
Now, just days ahead of the 10-year anniversary of that disaster, Haiti's population appears little prepared to face the next major shock, with millions threatened by hunger in 2020 due to a spiraling economic and political crisis.
Official mortality statistics for 2019 have not yet been made public, but doctors and medical staff working across the country tell CNN that unusually high levels of malnourishment are already claiming the country's most fragile lives -- and that more deaths are expected in the coming months.
Food insecurity headed for 'emergency levels'
Haiti has been on a rollercoaster of good intentions since the 2010 earthquake. Attention and donations from the rest of the world spiked in the immediate aftermath of the 2010 earthquake -- and then dropped. A deal with Venezuela known as PetroCaribe temporarily provided the country's government with cheap fuel, but then foundered and became linked to a scandal over the alleged mismanagement of the resulting funds.
Basic public services like hospitals and food access are supported by international aid organizations (which come with their own set of problems), but more and more Haitians simply cannot afford the food they need. According to the UN disaster relief organization OCHA, the cost of the most basic, joyless kitchen essentials in Haiti -- rice, wheat flour, maize, beans, sugar and vegetable oil -- jumped 34% this year alone.
"Marasmus (the medical term for starvation) was uncommon in Haiti since most families previously could afford rice or sugary drinks. That is no longer the case," said Freishtat.