Tens of thousands of Somalis are feared dead in the world's worst famine in a generation, the UN said, a crisis so severe that the United States is loosening rules meant to prevent emergency funds from falling into the hands of al Qaida-linked militants.
Exhausted, rail-thin women are stumbling into refugee camps in Kenya and Ethiopia with dead babies and bleeding feet, having left weaker family members behind along the way.
"Somalia is facing its worst food security crisis in the last 20 years," said Mark Bowden, the UN's top official in charge of humanitarian aid in Somalia. "This desperate situation requires urgent action to save lives... it's likely that conditions will deteriorate further in six months."
The crisis is the worst since 1991-92, when hundreds of thousands of Somalis starved to death, Mr Bowden said. That famine prompted intervention by an international peacekeeping force, but it eventually pulled out after two American Black Hawk helicopters were shot down in 1993.
Since then, Western nations have mainly sought to contain the threat of terrorism from Somalia - an anarchic nation where the weak government battles Islamic militants on land and pirates hijack ships for millions of dollars at sea.
Oxfam said more than £500 million is needed for famine relief. On Wednesday, the US announced an additional £15 million in emergency funding on top of the £266 million in assistance already given this year.
Most importantly, those new US funds will not be placed under restrictions implemented in 2009 that are designed to keep food and money from being stolen by Islamic militants.
Aid groups have called for the restrictions to be lifted entirely and say the rules have severely limited their operations.
Somalia is the most dangerous country in the world to work in, according to the UN's World Food Programme, which has lost 14 relief workers in the past few years. Kidnappings, killings and attacks on aid convoys occur frequently. Two years ago WFP pulled out of Islamist-controlled southern Somalia after the rebels demanded cash payments and other concessions.
The Horn of Africa is suffering a devastating drought compounded by war, neglect, poor land policies and spiralling prices. Some areas in the region have not had such a low rainfall in 60 years, aid group Oxfam said. Kenya, Ethiopia and Djibouti have all been badly affected, and Eritrea is also believed to be suffering, although its repressive government does not release figures.