SHASHEMENE, Ethiopia — Nine-month-old Alfiya Galeto weighed just 10 lbs. when she arrived at the makeshift clinic here, her eyes dull and her arms as thin as drinking straws. There was no food in their village, her mother said, and for weeks she'd been fed nothing but breast milk.
In the week after this clinic was opened by the medical charity Doctors Without Borders, nearly 300 children like Alfiya were admitted for severe malnutrition. In the poor farming villages around Shashemene, in drought-ravaged southern Ethiopia, aid workers believe that hundreds and perhaps thousands more children are starving.
A serious drought and the worldwide surge in food prices are fueling one of Ethiopia's gravest hunger crises in years, with 6 million children younger than five urgently needing food, according to the United Nations Children's Fund, or UNICEF. Relief workers say scores of children already have died.
But international humanitarian groups say the Ethiopian government has been slow to respond. Prime Minister Meles Zenawi's government hasn't publicly declared an emergency and, the agencies say, has downplayed their estimates of the severity of the situation.
Arid, overpopulated and chronically hungry, Ethiopia receives more food aid than all but a handful of countries worldwide — most of it from the United States, which has provided $300 million in emergency assistance to relief agencies in the past year. U.S. officials defend Ethiopia, a key regional ally, arguing that the government was caught off-guard by the extent of the drought and by how quickly malnutrition rates rose in recent months.
But there were warning signs.
A U.S. humanitarian assessment mission warned in January that humanitarian conditions "could significantly deteriorate" in the impoverished southeastern Somali region. By February — as rainfall remained scant, maize and other staple crops failed and inflation soared — international aid workers reported that malnourished children were showing up at hospitals in southern Ethiopia.
In an address to parliament on March 18, Meles said that reports of drought-related deaths were "false." It wasn't until last week that a delegation of Ethiopian emergency relief officials toured Shashemene and other parts of the drought-ravaged south. According to humanitarian officials who were briefed on the visit, the Ethiopians were "shocked" by the conditions and pledged to respond.
"It is absolutely critical at this stage that the government of Ethiopia recognizes the depth of its problem, and works to ensure that its children survive this crisis," said one senior international aid official who, like several interviewed for this story, requested anonymity for fear of angering Ethiopian officials.
The head of another international relief group said: "Is it a lack of information or is it denial? The government needs to recognize this is an emergency, to convene donors and to facilitate the arrival of assistance in the country."
Ethiopian officials weren't available for comment. But the inability to feed itself is at odds with the image that the government wants to project: that of a country on the rise, with annual economic growth of around 10 percent, fresh off a massive coming-out celebration last year to mark the year 2000 on the Ethiopian calendar.
At the Doctors Without Borders clinic in Shashemene, 150 miles south of Addis Ababa, 277 children were admitted in the first eight days. Hundreds more are in outpatient care in far-flung clinics in the countryside. In Seraro, a remote town about two hours from here, aid workers reported that 55 had died by mid-May.
The children in Shashemene are faring slightly better. Four have died, but the vast majority are slowly putting on weight thanks to a steady diet of fortified milk and Plumpy'nut — a protein-enriched, peanut butter-like paste often used in famine relief.
On a recent afternoon, a group of mothers smiled as 12-month-old Hirwot, who'd been admitted a week earlier with persistent diarrhea, weighed in at 3 pounds heavier and was transferred out of the ward reserved for the most serious cases.
Alfiya, the 9-month-old, looked in awful shape when her mother brought her in from their village 50 miles away. Her limp body was swallowed by a pale green sweater and flies buzzed about her head, which was scabbed with sores.
But Veronique DeClerck, a Belgian midwife who inspected the child, pronounced that she would survive.
"Now that she's here, she gets treatment and she'll make it," DeClerck said. "But the problem is when they go home, and there's still no food."
Relief agencies say they badly need more Plumpy'nut, vitamin-enriched milk, antibiotics and other treatments. Some agencies complain that the government continues to impose heavy import duties on emergency supplements like Plumpy'nut, which is taxed at about 50 percent.
Of $50 million needed for life-saving food and medical care, UNICEF says that donor countries have chipped in only $6 million.
"We are far from knowing the magnitude of the situation," said Francois Calas, country coordinator for the Belgian arm of Doctors Without Borders. "We can expect the coming months to be very difficult as well."
Relations between the government and relief agencies are severely strained. Last year, during a secretive military operation against rebels in the Somali region, also known as the Ogaden, the government temporarily expelled the International Committee of the Red Cross and teams from Doctors Without Borders from the area. Ogaden refugees have since described massive human rights violations by Ethiopian soldiers.
Earlier in 2007, the government refused to declare a cholera outbreak that killed hundreds of people and infected more than 60,000. Despite U.N. tests showing that the epidemic was indeed cholera, Ethiopian officials insisted on calling it "acute watery diarrhea," which may have slowed the international response, aid officials said.