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Hunger is again stalking East Africa. The United Nations says 20 million people will need emergency food aid before the end of this year in six nations - Ethiopia, Eritrea, Somalia, Kenya, Uganda and Sudan. Poverty and drought are challenging the best efforts of the government and international aid agencies to save the lives of malnutrition victims.
Driving through Ethiopia's countryside, it is hard to imagine a food shortage.
But these lush fields mask what experts call a "green" drought, one of the worst in recent memory. Three years of poor rains have dealt a harsh blow to Ethiopia's agricultural economy. Lake beds are drying up.
Changing weather patterns have turned what used to be a recurring problem into a chronic one, and a constant headache for Ethiopian Prime Minister Meles Zenawi.
"There are always malnourished children somewhere in Ethiopia every year," he said.
Fitsum Taeme is on the front line of Ethiopia's battle against malnutrition. "They are dying at the community level," said Fitsum.
Fitsum is a 21-year-old nurse at a health center operated by Care International. 23-year-old Meron Assefa works at a nearby center run by the Irish NGO, GOAL.
Every day they and thousands of others like them receive new malnutrition cases, treat the ones they can, and transfer the severely ill to hospitals.
They are part of an army of new nurses - 6,000 new graduates each year - that are part of Ethiopia's strategy for responding to malnutrition, staffing a rapidly expanding network of community health centers.
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Ted Chaiban, Ethiopia country director for UNICEF, says these newly built centers are saving 40,000 lives a year.
"The capacity to do so has increased from less than 200 sites in 2007 to over 3,200 sites right now in hotspot districts," he said. "Over the year, if needed, we could manage between 150,000 to 200,000 children."
But supplies are critically short. The World Food Program estimates it needs an additional 120-thousand metric tons to meet Ethiopia's nutrition needs through the end of the year. The government says 6.2 million people will need food aid in the coming months.
Ethiopia's disaster relief agency chief Tadesse Bekele acknowledges that children are dying of complications of malnutrition, including TB and diarrhea. But he says he and his relief workers will not accept that children will die of simple malnutrition.
"There may be deaths because of health issues, but no one should die because of lack of food. That's our principle," said Bekele.
With severely malnourished children turning up daily, many with complications, Tadesse Bekele and his disaster relief agency have their hands full.
Nurse Azeb Malke at the town of Karsa says she's referring a steady stream of youngsters with tuberculosis complications to the nearby regional Bisidimo Hospital.
"Eight-zero children have been transferred to Bisidimo [hospital]. Especially 70 percent pulmonary tuburculosis cases," she said.
Experts predict this third straight year of drought will lead to even more difficult times in 2010, at least until the next harvest is due.
In the meantime, thousands of young Ethiopian nurses are graduating, more health centers are opening, and donors are slowly opening their pocketbooks to provide desperately needed food aid.