Relief agencies say the Horn of Africa is showing signs of acute food insecurity, including the sale of family assets like livestock for survival and migration in search of food. There is also a growing number of people suffering from malnutrition. Humanitarian aid groups say more than six-million people in the Horn may be in need of help.
Health worker Margaret Aguirre was alarmed at the sight of the little boy. His mother, named Adena, had brought the severely malnourished seven-year-old to the therapeutic feeding center run by the International Medical Corps.
"It was quite frightening to see him - he was skin and bones. To say his ribs were poking out is an understatement," she said. "He could barely stand, and she had to hold him. The child is tall and it was upsetting to see the child could not stand. His mother had to carry him into the clinic."
Health experts say families like this have run out of ways to survive.
Drought means no pasture for their livestock, which provide the family with milk. Some sell off livestock, tools and other family assets to buy food. Others eat seeds needed for planting or survive on foods like the false banana, or enset, which has few calories or nutrients. By the famine stage, families and entire communities have often left in search of food.
It was a similar situation for Ethiopia Director Aine Fay, of the Irish NGO Concern Worldwide. She describes a child she met at one of her group's feeding stations.
"He was a one-year-old [Abraham Adwiro] and weighed 4.2 kilograms. [The father], who had migrated in search of labor and the money, had not come back," she said. "In the meantime, this one-year-old had deteriorated to the point where food alone was not going to help him. We gave him both food and medicines. He needed antibiotics for an infection."
Concern is helping more than 50,000 children and mothers in Ethiopia. Many children show up at any one of its many therapeutic feeding centers with the large sores and swollen bellies of kwashiorkor, a condition linked to a lack of protein. They may also show wasting, or marasmus.
International relief agencies are working to prevent adults and children from reaching famine levels.
That includes two deaths for every 100,000 people, due in part to a daily consumption of less than 2,100 kilocalories of food, and four liters of water.
To alleviate acute malnutrition in Ethiopia, Concern is giving out 8.3 kilogram packages of fortified flour and a liter of cooking oil as supplementary food for thousands of malnourished children and pregnant mothers.
Children are also given a high-nutrition formula called F75 or a high protein, ready-to-eat peanut paste called plumpy nut.
Similar help is also offered at the supplementary feeding centers of the International Medical Corps, which also focuses on long-term solutions to acute hunger. They include providing clean water and sanitation, and efforts to teach people to plant nutritious foods in their own gardens.
Margaret Aguirre says the situation in Ethiopia is severe, but she notes that there has been an improvement in rainfall recently and says that for now, that should move some pockets of the country away from famine.