The famine gripping parts of southern Somalia has spread to three more areas, with the entire south likely to be declared a famine zone within the next six weeks.
Acute malnutrition and death rates have surpassed famine thresholds in the Balcad and Cadale districts of Middle Shabelle, and among the refugee populations in Mogadishu and the Afgoye corridor, said the UN Food and Agriculture Organisation's Somalia food security unit.
"(The) current humanitarian response remains inadequate, due in part to ongoing access restrictions and difficulties in scaling up emergency assistance programmes, as well as funding gaps," the group said.
Much of southern Somalia is controlled by al-Shabaab Islamist militants, who last year banned food aid and kicked many aid groups out of the region, exacerbating the crisis.
Famine conditions were expected to persist across southern Somalia until the end of the year, the UN agency said. Each day hundreds of Somalis are streaming into squalid camps in and around Mogadishu, defying rebel orders not to leave their homes. The start of Ramadan two days ago coincided with a new offensive by peacekeepers and government forces against the insurgents and a rise in suicide attack threats.
The violence has compromised the delivery of emergency aid to some 100,000 refugees who have arrived in Mogadishu in the past two months, bringing the total to around 400,000.
"Local doctors came to us this morning and said two of my children are malnourished and anaemic. We were given a few days' worth of food but we have no shelter, not even plastic sheets," said Hawa Omar, a mother of seven. She is in a makeshift settlement of about 4,000 newly arrived refugees, six miles from the frontlines where government forces engage the rebels in daily gun battles.
The UN refugee agency, UNHCR, said it was able to distribute relief through local networks but work to assess the needs of new arrivals had been slowed. "The plan was to start the assessments in about 10 other settlements in the coming days but all the movements have been restricted since the offensive," said Andy Needham of UNHCR Somalia.
Drought, conflict and a lack of food aid have left 3.6 million at risk of starvation in southern Somalia. The drought has affected about 12 million across the Horn of Africa.