Oecussi – Sika and Siska were not born prematurely and yet between them the twins weigh a little over four kilograms (nine pounds), a testament to food shortages gripping impoverished East Timor.

"The food shortages here touch all ages: the babies, the men, the women," explained Cuban doctor Orestes Laza at the main hospital in Oecussi town, where facilities are still very basic. "The only supply is rice and vegetables," he said.

More than 90 percent of the doctors in East Timor are from Cuba, thanks to a cooperation agreement between Dili and Havana.

Often infants remain in good health as long as they are breastfed, added Laza. But Nonak, the mother of Sika and Siska, does not have enough milk, probably because she is malnourished herself from a poor diet of just rice.

The 29-year-old lives in a village seven kilometres (four miles) from town in the mountains. East Timor's farmers depend on traditional agriculture for their food, mainly rice and corn.

But poor weather and a recent plague of locusts have caused a 30 percent decline in crop production in the last year, East Timor's UN humanitarian coordinator Finn Reske-Nielsen warned earlier this month.

This leaves "one fifth of the population, or more than 200,000 people, vulnerable to food shortages during the coming lean season, which runs from around November to around February," he said.

Oecussi is among the six worst-hit districts out of the 13 in East Timor.

Maria Sore, 45, is another malnutrition victim. She appeared extremely weak lying in her bed, her husband at her side who confirmed their desperate plight. "We live in the mountains and we do not have any more rice to cultivate. There remains a little corn but the rice plantations were made barren by the dryness," Adolfo Siqueira said.

Oecussi, an area of some 2,700 square kilometres (1,080 square miles), is an East Timorese territory surrounded by Indonesia's West Timor province.

The quirk of its existence is historical: Oecussi was the arrival point of Portuguese Dominican missionaries to Timor in the middle of the sixteenth century, from where they spread their Roman Catholic religion. Though the colony was integrated into Indonesia without protest in 1976, it politically remained closely connected to East Timor.

But it takes 12 hours by ferry to get there from Dili, the capital of East Timor. "Oecussi was always more vulnerable because it is an enclave," said Dorte Jessen from the UN's World Food Programme (WFP).

Here a kilogram of rice costs 50 cents, compared to 40 cents elsewhere in the country, due to the cost of transportation. Importing is difficult, she said, "because all the countries in the region need more rice".

The UN's Food and Agriculture Organisation and WFP estimate that the cereal deficit for East Timor this year and next will reach 86,364 tonnes. With commercial imports anticipated at 71,000 tonnes, the shortfall needs to be filled through food assistance.