Refugees have been trudging out of drought-stricken Somalia for months, leaving their dead children behind and carrying survivors in a desperate trek to find food.
On Wednesday, the hunger and death unfolding in the Horn of Africa officially got a name: famine.
It's a technical term — except for those walking for weeks to refugee camps in Kenya in a last-ditch hope to save their families.
For the United Nations to declare a famine, as it did at a Nairobi, Kenya, news conference, child malnutrition must be 30 percent or higher, and daily deaths at four children per 10,000 people.
According to UNICEF, the U.N. agency that focuses on children, child malnutrition rates in southern Somalia have doubled in a single month — in some places to 55 percent and infant deaths have increased to six per day.
"If we don't act now, famine will spread to all eight regions of southern Somalia," said Mark Bowden, author of Black Hawk Down and now the United Nations' humanitarian coordinator for Somalia. "Every day of delay in assistance is literally a matter of life or death."
Speaking at the United Nations, Secretary General Ban Ki-moon said that nearly half of Somalia's population — 3.7 million people — are now in crisis. A total of $1.6 billion is needed to help, he added, with about $300 million of it required in the next two months to mount an "adequate response."
On Wednesday, the United States announced an additional $28 million in emergency funding on top of the $431 million in assistance already given this year.
"In Somalia, 20 years without a central government and the relentless terrorism by al-Shabab against its own people has turned an already severe situation into a dire one that is only expected to get worse," Secretary of State Hillary Rodham Clinton said in a statement.
But some aid agencies criticized the United States and other Western donors Wednesday for failing to respond to the crisis quickly enough, despite numerous calls for assistance.
"The crisis has been building for several months but the response from international donors and regional governments has been mostly slow, inadequate and complacent," Fran Equiza, the regional director of the British aid agency Oxfam, said in a statement.
Equiza said that there was still an $800 million shortfall in funding, adding "by the time the U.N. calls it a famine, it is already a signal of large-scale loss of life."
The Islamist militants who forced Western aid organizations out of Somalia last year, right as the drought was looming, are now urging the groups to return. But aid officials are wary, citing the dozens of workers who have been killed in Somalia in recent years. Also hampering the emergency efforts, aid officials contend, are U.S. government rules that prohibit material support to the militants, who often demand "taxes" for allowing aid deliveries to pass through.
It's the worst African hunger crisis in 20 years, according the Rozanne Chorlton, UNICEF's representative on Somalia. The last time things were this bad in Africa was 1991. Then, as now, it was in Somalia.
UNICEF has doubled its food, health and water programs in Somalia, Chorlton said.
Information from the Los Angeles Times, Washington Post, and New York Times was used in this report.