During the second phase, red to purple, hard knots develop in the affected areas. The infection spreads to other soft tissue, such as lips and cheeks. The affected tissue gets swollen, the patients suffers from high fever, strong pain, puss and foul mouth odor.
Intervention is crucial, since Noma can still be stopped at this stage. Therefore, one of the Hilfsaktion's focuses is to sensitize parents, nurses, traditional healers and schools so that they can spot the early signs of Noma. The affected children can then be brought to one of the organization's stations in Niger. Here they are examined and treated.