To save themselves, Rahmo Ibrahim Madey and three of her children escaped on foot this month from southern Somalia's Bakol region — a drought-racked land controlled by the Islamist militants of the Shabab group.
Less than 20 miles from their destination, the battered capital of Mogadishu, Madey's 1-year-old daughter, Fadumo, died of starvation.
Days later, under a shelter of plastic sheeting and castaway fabric at one of the makeshift refugee camps in the capital, the 29-year-old mother spooned small helpings of porridge into the mouth of her 4-year-old daughter, Batulo.
"She is dying," Madey said, knowing she could do nothing. The porridge was the family's last bit of food, and it made no difference for the girl. She died within minutes.
The camp, built around government buildings whose shell-scarred ruins are evidence of Somalia's long civil war, is crowded with about 2,000 people, and more arrive every day. Many bring tales of loss and suffering.
They are refugees not just from persistent drought but from Somalia's war, and they represent only a few of the estimated 10 million people facing severe thirst and hunger in the Horn of Africa — parts of Somalia, Kenya, Ethiopia and Djibouti.
Shabab, which has been fighting the Somali government for years, has sharply limited the access of aid agencies in regions of the country it controls. Days ago, the group announced it was lifting the ban, but no one could be sure how much help would arrive or how soon.
"It's obviously good news, but it takes some time before we're on the ground. There are logistical pipelines that need to be set up," said Gabriella Waaijman, East Africa regional head of the U.N. Office for the Coordination of Humanitarian Affairs.
Every day, she said, about 1,500 refugees are pouring into aid camps in Ethiopia, while another 1,500 are struggling to make their way toward camps in Kenya. Almost all the current refugees are Somalis, she said.
"The main reason we're seeing so many coming across the border into Ethiopia and Kenya is we couldn't reach them where they live," Waaijman said.
At Dadaab in northeastern Kenya, whose three camps together make it the largest refugee complex in the world, about 372,000 people jostle for space in a complex built in the early 1990s to hold just 90,000.
With 1,300 new arrivals every day, the 31-square-mile complex "is effectively the third-largest city in Kenya," said Stephen Gwynne-Vaughan, director of the aid agency CARE International in Kenya. "And if you look on a map it's not even there."
Most of last year, he said, the influx of refugees was a more manageable 4,000 a month. Last month, he said, the numbers had risen to above 1,000 a day. The Kenyan government gives the refugees only temporary asylum, though it sometimes lasts for decades. A tiny number are relocated to Western countries.
Gwynne-Vaughan called the crisis in the Horn of Africa "probably the worst humanitarian disaster" in the world. Some parts of Kenya have seen less than a tenth of their average rainfall over the last two seasons, he said. Many people had not fully recovered from an earlier two-year drought, which ended with the rains of 2009.
People walk for days to reach the camps, and during the trek are vulnerable to starvation, thirst and attack. There have been reports of people leaving their children in the bush along the way because the children are too weak to go the distance, he said, though this is difficult to verify.
"This is a protracted emergency," Gwynne-Vaughan said. "All that distance in between is where they're most likely to be killed."
Many Somalis are pastoralists who for years followed their animals from dry land to better grazing areas, often venturing into Ethiopia and Kenya. But the fighting in Somalia, tighter borders and land disputes have altered migration patterns.
"They're left with few options," Gwynne-Vaughan said. "Certainly there's no single easy solution. The ultimate solution is peace in Somalia. That's out of our control."
Goffard reported from Nairobi and special correspondent Mohammed from Mogadishu.