Famine relief efforts in Somalia are being hampered as much by delays in procuring food aid and raising funds as by difficulties in accessing Islamist-controlled areas, according to humanitarian organisations working there.
The al-Shabab rebel group, which controls most of the south, including the main famine zones, has refused to lift the bans it has imposed on several humanitarian agencies over the past two years. Barred organisations include the World Food Programme, which usually leads drought responses.
But several other international aid groups, including Islamic Relief, Unicef, and the International Committee of the Red Cross (ICRC) are operating across the al-Shabab-controlled zones, as are numerous Somali non-governmental organisatons.
Staff at these agencies say the major problem in responding to the crisis is the time it is taking to buy food abroad and to transport it to the worst-hit areas.
"The limits on our action are more on the side of logistics than access," said Anna Schaaf, spokeswoman for the ICRC in Nairobi. "To purchase 3,000 tonnes of food [which the ICRC is distributing] and get it there is a long process."
Unicef said it had taken 20 days to source soy-blend products – a key part of aid for malnourished people – from India, and twice that long from Europe. The UN children's agency said while it was sending 11 flights to Somalia this week, its efforts were "still not to scale and not enough".
Tony Burns, director of operations for Saacid, the oldest NGO in Somalia and which works throughout the country, said despite the size of the crisis "funding is still very difficult to get", adding: "Al-Shabab is an issue in responding to the famine, but for us it's more about finding the resources so we can help people."
The lack of food stockpiling in Somali reflects badly on the international humanitarian community, Burns said, since the severity of the drought was known for many months before famine was declared in the Bakool and Lower Shabelle regions two weeks ago. A further three areas were added to the famine list on Thursday: parts of the Middle Shabelle region, the sections of Mogadishu that host communities who have fled their home areas, and the Afgoye settlements near the capital, which house 400,000 displaced people.
The UN estimates tens of thousands have died from hunger-related causes across the country. Other countries in the Horn of Africa have also been hit by the drought, but it is the corrosive effect of 20 years without a government and civil war that has driven several million Somalis to the brink.
Reports suggest insurgents may be blocking some in the south from fleeing to refugee camps, but Burns said the rebels "are not monolithic" and could be talked to. "They are hardcore in some places, and very moderate in others," he added. "In areas where they are not so strong, it is more than clans that make the rules."
Islamic Relief, a British charity, has managed to negotiate with the rebels to gain access to the worst-hit regions, and is distributing food to 16,000 households.
Hassan Liban, its director of emergencies, said the situation had eased in parts of Lower Shabelle with the arrival of monsoon rains. But conditions in the Bay region in particular were extremely bad, with three to four children dying every day in a makeshift camp for 7,500 families in Baidoa.
"In terms of deaths, it is mainly children," he said. "But people are weak and if we don't act more people are going to die. They are in bad shape."
Lack of food and water has caused entire villages to flee their homes for the nearest towns. Prices have shot up: 10,000 litres of water trucked in costs $700 (£430), five times more than Islamic Relief had budgeted for.
Liban said rebel authorities were not keen on emergency relief that was not tied to longer-term programmes to help people recover their livelihoods: "To any organisation that just wants to send food, they [al-Shabab] say: 'Give us the food and go away'. But if it's sustainable and planned they will allow you to work. Plans must be in tandem with their thinking."
The insurgents are also extremely suspicious of non-Muslims, meaning that the international aid agencies working in the al-Shabab areas cannot use western staff. For most UN aid workers the restrictions extend to Mogadishu, where the government holds about 60% of the territory, owing to security concerns.
Liban said the scale of problem meant that humanitarian organisations not operating in the rebel-held famine regions were still desperately needed, whatever the reservations about al-Shabab are: "Our call is for most institutions to have negotiating positions and to open dialogue to access these areas. We need to save lives."