A month after famine was first declared in Somalia fewer than one in five of the 2.8 million starving people in the south are getting help. Continued conflict and the banning of aid organisations by the al-Qa'ida inspired Islamist group al-Shabaab has made it impossible for large-scale aid to get through.
The lucky ones make it to refugee camps in Mogadishu or in neighbouring Kenya, Ethiopia or Djibouti, but for the majority help is still a long way off. Many have been forced to remain in Somalia by al-Shabaab militias, who believe it is better to die than take to food from infidels.
While al-Shabaab has retreated from Mogadishu, which is now controlled by a weak UN-backed interim government and 9,000 African Union troops, the terrorist group still has control of areas outside the capital.
The continued conflict has combined with the worst drought in decades, pushing 3.7 million people to the point of starvation. More than 30,000 children have died and as many as 500,000 more will be killed by hunger without immediate aid. All told, there are now nearly 13 million people at risk in the region .
Some believe the situation in Somalia is so desperate that the only way of getting help to the starving in the south and central regions is to introduce "safe" corridors for aid, policed by a peacekeeping force. Experts say fears of a repeat of the disastrous UN military intervention of 1993, immortalised in the film Black Hawk Down, have prevented this from being tabled.
The Irish charity Goal believes that the British government should exert pressure on the UN Security Council to deploy peacekeepers to Somalia. John O'Shea, Goal's chief executive, said: "Al-Shabaab say they would rather all Somalis died of starvation than accept Western food. This is not a famine; this is a war. The international community appears to be almost entirely focused on refugee camps in Ethiopia, Kenya and Djibouti, and on feeding programmes in Mogadishu, when these only represent an overspill from the heart of the crisis. The fact is that four million of the worst-affected people are trapped inside Somalia."
Ben Rawlence, author of a Human Rights Watch report detailing abuses inflicted on Somalis by both al-Shabaab and the interim government, said: "I don't think there are any easy solutions. Peacekeepers with World Food Programme convoys are not the answer. You don't want to introduce another armed factor into what is already a very messy civil war."
Of the 1.4 million children affected by the food crisis in Somalia, 390,000 are suffering from malnutrition and 140,000 in the south-central region face imminent death. Organisations such as Oxfam, which are unable to operate outside Mogadishu, are instead helping to train and fund local organisations that can go into the al-Shabaab-controlled regions.
Turkey last week tried to rally Islamic countries by hosting a donor conference with delegates from 57 Muslim states. Aid from Muslim nations would be unlikely to face the same obstruction from al-Shabaab. On Friday Recep Tayyip Erdogan, Turkey's Prime Minister, became the first non-African leader to visit Mogadishu in 20 years.
Even in Mogadishu help is not guaranteed. Thousands of sacks of food aid have been stolen. The World Food Programme (WFP) has been investigating food theft for two months but says the scale of the crisis means suspending its service is not an option.
Meanwhile, in Kenya, the WFP has scaled back a blanket feeding programme in the remote Turkana region because of a lack of money. It had intended to feed all children under five who are at risk, but has had to limit help to the under-threes.
Thandie Mwape, a UN humanitarian affairs officer in Kenya, said: "There's a gap in funding because donors are not coming. There is a danger when you leave out under-fives; they are a priority. But if the money is not there, you have to target the most vulnerable ones."
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