Jason Burke reports from Baidoa in Somalia, where more than 6 million people need assistance after two years without rain

There is no road to the hundred or so tin-roofed shacks scattered among scrubby trees that make up the village of Erdon, only a dusty track tracing a narrow path for 10 miles through the bush from the central Somalian town of Baidoa.

One morning last week, Iman Adam attended lessons given by a local cleric under a large tree. Afterwards the seven-year-old played and helped her mother with household chores.

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As dusk approached, Iman began to vomit. Then came diarrhoea. Within hours, she was fading fast. Neighbours told her mother, Sadiye Ibrahim, of a new clinic in Baidoa that might save the child’s life. She strapped her now unconscious eldest to her back with a shawl and ran through the gathering night.

A fit, healthy adult could cover the distance to the town in two or three hours. Sadiye, weakened by weeks of living on a few handfuls of sorghum and a few litres of filthy water each day and carrying a sick child in the dark, took much longer. She arrived at the clinic close to midnight. Her daughter died a few hours later.

“We don’t know this disease. We have never seen this,” she said shortly after Iman’s funeral.

Facebook Twitter Pinterest Sadiye Ibrahim. Photograph: Jason Burke for the Guardian

Hunger threatens Somalia again. With dearth comes disease, and with disease comes death.

Sadiye’s child was killed by cholera or a related bacterial infection, contracted because of poor sanitation. She suffered massive fluid loss leading to shock and organ failure. Cholera can kill a malnourished and dehydrated child in hours. It is easily treated, but only if the sick can get medical help fast. Endemic in Somali, cholera and other diseases are now spreading faster and further than anyone has seen for many years.

The drought too is the most severe in living memory. Aid agencies believe more than 6 million people in Somalia need assistance, of whom about half are threatened with famine. Two years have gone by without rain. Cattle are dead, wells dry and fields empty.

Earlier preparation and a generous response to appeals for funds mean the terrible scenes of the last famine in Somalia six years ago, which is thought to have killed 250,000 people, may yet be averted. But no one is certain. Some aid workers use studies of the 2011 famine to predict that at least 60,000 people are likely to die this year in a “best-case” scenario.

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In the villages around Baidoa, and across the worst-hit areas of southern and central Somalia, the toll is mounting. There are scattered deaths from lack of food, but illness is the main killer. Spend an hour with those pouring into the town, 180 miles north-west of Mogadishu, and you will find fathers who have buried four children in as many days, grandparents left to fade away in villages and breastfeeding mothers who have carried twins for 70 miles under a searing sun in a last ditch bid to find help.

Aid authorities also admit that an official UN figure of about 550 deaths as a result of cholera and similar diseases in Somalia since the beginning of the year is “grossly underreported”. The true figure could be 10 times as many, or more. Save the Children has set up five health facilities in Baidoa. In the clinic where Iman died, they have treated 1,900 cases since February. The charity’s three mobile teams reached remote villages last week and dealt with 750 cases in three days.

It is clear to all that the worst is yet to come. Half a million Somalis have left their homes, heading for towns and cities. Twice as many may well be on the move by the end of the year – almost a tenth of the country’s population of 11 million. About 100,000 new arrivals are living in makeshift camps on the outskirts of Baidoa.

“It is very, very concerning … All the classic signs of a famine are there,” said Hassan Noor, Save the Children’s Somalia director.

Facebook Twitter Pinterest A child in a clinic supported by Save the Children in a camp in Baidoa, central Somalia. Photograph: Jason Burke/The Guardian

Even if desperately needed seasonal rain due in May arrives, it will take months for new crops to grow. And the rain means diseases linked to insanitary conditions and contaminated water will get worse.

The situation in Somalia is just one link in a chain of crisis that stretches thousands of miles from north-eastern Nigeria, through South Sudan and eventually to Yemen. In all, more than 20 million people are threatened with famine. UN officials say the crisis is the largest since the organisation was founded in 1945.

Michael Keating, the top UN official in Somalia, said the international community’s reaction so farhad been very impressive but needs were “outpacing the ability to respond. If it doesn’t rain we have one type of humanitarian problem, and if it does, we have another,” he said.

Reaching those most in need is a major challenge. The worst-hit communities in Somalia live in rural areas where the authority of al-Shabaab, Islamic militants linked to al-Qaida, is strongest. The group once held much of the country, but repeated offensives by regional peacekeepers and Somali fighters backed by US airpower have forced them out of the major towns. Baidoa may be under government control, but the surrounding villages are a zone of shifting allegiances where extremists, clan militias and government forces compete for power.

“The government soldiers come, often in the day, and the [extremists] come, usually at night, but no one helps,” said Ali Mohammed Mursa, an elder from Herera Ful village who led his two wives and 10 children to Baidoa two weeks ago.

Al-Shabaab has previously banned international humanitarian organisations from the swaths of countryside it controls. Last week two convoys of aid workers were hit by roadside bombs in Mogadishu, in the latest of hundreds of such attacks on humanitarians across the country. Reaching up to 2 million of Somalia’s most needy people is often dependent on fragile local agreements with individual low-level al-Shabaab commanders, aid agencies say.

The result is an exodus from areas controlled by the group. At a second camp outside Baidoa, exhausted new arrivals trudge in.

Facebook Twitter Pinterest A malnourished child is fed a special formula by her mother at a regional hospital in Baidoa. Photograph: Tony Karumba/AFP/Getty Images

“There is nothing where we come from. The cattle are all dead, there is no food we can afford … if we stay we will die,” said Hawa Ali, who had walked for eight days with five other families carrying two newly orphaned infants. Many leave it too late, and the journey can be too much for the weak.

Adnan Muktar, 36, had buried two of his five children by the roadside as they walked from Wajit, 60 miles away. “They died because we had no water. I knew how weak they were. I was coming here to save them,” he said.

Aid agencies are doing what they can. Save the Children has distributed cash and food to tens of thousands of households in Baidoa, and has operations across Somalia. Local communities are also helping, largely through their mosques, as are Somalis overseas.

“Civil society, religious leaders, the diaspora, the government ... we are all working day and night,” said Abdirahman Yarisow, the information minister.

But the size of the influx is swamping all efforts. Seven thousand people now live in small domed shelters of wood and cloth on a single small clearing among thorn bushes on the edge of Baidoa. The unplanned camp has no sanitation, and its inhabitants receive only a bare minimum of water from the UN. Their food supplies are exhausted. Every hour brings new arrivals, and the first cases of acute watery diarrhoea or cholera have been registered.

Sadiye did not see her daughter die. She had no choice but to leave her in the care of nurses. She returned to her village, running once more through the bush at night, to pick up her second daughter, Momeno. The four-year-old was also ailing, fluids pouring from her on to the dirt floor of their home. By the time she arrived back at the clinic, preparations were being made for Iman’s funeral.

Momeno is now doing well, nurses say, and will almost certainly survive. But Sadiye’s mother has now called to say her two-year-old is ill too.

“This disease … this drought … we have never seen this,” Sadiye said.

Facebook Twitter Pinterest A displaced child rests in Baidoa. Photograph: Jason Burke for the Guardian

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