|World Food Bank Programme director Josette Sheeran says that many of the children arriving at refugee camps are already in Stage four malnutrition, meaning they have a less than 40 per cent chance of surviving [EPA]
In Somalia, where civil war has ravaged the country, where conflict continues to claim victims, a new hardship is being visited on the innocent.
Thirty years ago the world rallied to help the famine victims of Ethiopia and across the Horn of Africa, and vowed never again.
Now, after the worst drought in the region in 60 years, thousands are dead, thousands dying and more than 11 million people are at risk.
The drought was officially declared last week by the United Nations, and the international community is now trying to co-ordinate an action plan.
They gathered in Rome at the headquarters of the United Nation's Farming and Agriculture Organisation (FAO), the representatives of 191 countries, of non-government organisations, of charities and aid groups.
They were told by the foreign minister of Somalia's government in exile Mohamed Ibrahim: "The people of Somalia now face widespread famine for a wide array of reasons, extremely low rates of rainfall for the past two years, al-Shabab's blockade of humanitarian and aid agencies access to the needy, the vulnerability of the Somali people and the continual chaos and instability throughout the region".
Famine in a failed state
The problem of access has dominated much of the discussion. Somalia is a failed state. The rule of law is ignored and the Islamist fighters of al-Shabab control large parts of the country. They have in the past banned international aid agencies from working in the area with threats of extreme violence. In early July it said would accept groups it had blocked. But just last week, it again said it would stop groups it considered Western or ''Christian". And so people continue to starve, blocked from the help that could save them.
The famine is biting in Somalia, but 11 million people in Ethiopia, Kenya, Djibouti and Eritrea are also struggling to find enough food to eat. The drought has destroyed crops, conflict has forced people to run from the areas where they live, and - crucially - where they farm. The drop in production has led to a spike in demand, sending food prices soaring beyond the reach of most ordinary families. Refugees are spilling out of Somalia, heading to refugee camps where they hope not for a better life, but simply for the chance of one.
Josette Sheeran is the head of the UN's World Food Programme. She arrived at the conference on the overnight flight from East Africa, having toured the areas most affected.
She saw thousands of Somalis slowly making their way to the temporary camps which are now almost bursting with exhausted, emaciated people. "What we saw is children who are arriving so weak that many of them are in stage four malnutrition and have little chance - less than 40 per cent chance - of making it," she told the delegates. "We also heard from women who had to leave babies along the road and make the horrifying choice of saving the stronger for the weaker or those who had children die in their arms," she added.
Sheeran, who has been credited with bringing a new dynamism to the World Food Programme, denied that the world had ignored warnings that a crisis was coming, only waking up when pictures of dead babies started to fill the TV screens. "This drought is worse than the one in the 1980s, but fewer people are dying because of the programmes put in place, the early-warning systems and the resilience measures that have been introduced. It's still too many and we need to work to save lives."
Kanayo Nwanze is an agricultural specialist who runs the UN's International Fund for Agricultural Development. He welcomes the international intervention but believes Africa should be doing much more to help Africans: ''If Africa does not get its house in order and expects the world to help us out, we are dreaming", said Nwanze. And he told me, "Tanzania, Kenya and Ghana are moving ahead with agriculture but less than ten countries have fulfilled the pledge they made in 2003 to set aside ten per cent of their budgets for agriculture".
Nwanze pointed out that 30 years ago, Africa was a net exporter of many foods. "Now it imports. And that is due to bad governance."
The international community has pledged many millions to help with the immediate crisis, but Barbara Stocking of the charity Oxfam believes that short-term fixes don't help the long-term problems. Describing the famine as "shameful", she said, "We have not had the investment in small producers across the world that was expected. The money has simply not come through". And she insisted that people must hold their governments to account when they promise money to help and then don't follow through.
As one delegate told me: "People are dying in the drought in the Horn of Africa because the rains failed. The international community can't afford to do the same."
Follow Alan on Twitter @alanfisher