Somalia has been in the grip of a civil war since 1991. The state has disintegrated, leaving powerful clans to fill the vacuum. With the government weak and dysfunctional, the country is on the verge of another famine.
Nurses at Banadir hospital in Somalia's capital, Mogadishu, have rolled sheets of paper into small funnels and taped them over the hands of a little boy. It's a cheap way of preventing the emaciated child from pulling the feeding tube out of his nose.
"I don't know what's wrong with him," says his mother, Faduma. "When I tried to feed him, he started vomiting immediately and he had diarrhea." The boy has also been diagnosed with pneumonia.
In a neighboring bed, Hawa squeezes a paste of energy-rich peanut butter into the mouth of her daughter, Xamdi. The three-year-old can now swallow by herself, so nurses have removed the feeding tube she needed when she first arrived at the hospital 12 days ago. In the evenings, Xamdi's fever returns but at least she's gained some weight. She now tips the scales at seven kilograms - half of the normal weight for her age.
"There was nothing to eat at home and our children were getting weaker and weaker. That's when we decided to leave," says Hawa. The family walked for eight days under the cover of darkness - for fear of encountering Islamist al-Shabab fighters who oppose international aid.
"We live out in the countryside with our animals. There's no hospital or help out there", Hawa says.
The families of Hawa and Faduma are nomadic herders. Used to water shortages and harsh conditions, they traditionally pack up and move their camel and goat herds in search of fresh pastures and water. "We're just focused on our animals. We follow the rain," explains Hawa.
But it's raining much less than it used to in Somalia. In the past three years, back-to-back droughts have swept the country and evidence is mounting that climate change is driving up the temperatures in the region, exacerbating the problems of the scarce rainfall. The Horn of Africa is turning into a steppe.
After the rain had failed for a third time, Hawa and Faduma's families lost almost all of their livestock. Their livelihood has been destroyed, but they still plan on returning home when their children are better. Hawa and Faduma cannot imagine another life, and the shattered state is not offering them any alternatives.
Other families have already been cut off from their traditional lands. Clan violence, terror and hunger turns them into refugees within their own country. Most internally displaced people seek refuge in the greater Mogadishu area where they are not out of danger.
"Most patients are living in overcrowded refugee camps, where there is not enough food or clean water," says Bishara Suleiman, a field health officer for the International Committee of the Red Cross (ICRC). Between January and July 2017, the 28 clinics supported by the ICRC in Somalia treated almost 37,000 people, mostly for acute respiratory illnesses and diarrhea.
"Malnutrition destroys the immune system," explains Bishara Suleiman. "Malnutrition itself is preventable but it is so widespread due to the collapse of the health system. Malnourished children and elderly people are particularly susceptible to infectious diseases, such as pneumonia or cholera." Chronic malnutrition also sets children back in their long-term development because it impedes neural development.
Political failure causes hunger
Since dictator Siad Barre was overthrown in 1991, rival clans and warlords competing for power in Somalia have torn the country apart. Although the country has a new government since February 2017, it faces a resilient insurgency from Al-Shabab extremists seeking to establish an Islamic state based on Sharia law.
Both threaten the ability of humanitarian aid to arrive where it is needed most. The Islamist militants have imposed a ban on aid in areas it controls. Elsewhere, corrupt middlemen and authorities divert aid supplies for their own profit. Corruption is deeply entrenched in Somalia.
At a small market on the Via Roma in Mogadishu, for example, a 50 kilogram sack of rice intended as food aid from the World Food Program is on sale for $23 (19.50 euros). Buying in bulk earns a discount.
Read more: New beginning for failed state Somalia?
Michael Keating, the United Nations Special Envoy for Somalia, believes that widespread hunger in Somalia can be directly attributed to political failure.
"In functioning societies, in which the institutions work reliably and in which freedom of expression prevails, there is hardly any hunger," he says. "It is something that always affects the poorest and weakest members of society. It is a direct product of social, economic and political processes."
According to the UN, almost seven million people in Somalia, or half the population, currently depend on humanitarian aid. About 800.000 are on the brink of starvation. The Western-backed government wants to build a new, federal state. Foreign diplomats and businessmen are flocking to the country, including crisis profiteers hoping to turn a quick profit. Rents are skyrocketing and a housing bubble has developed in the capital. Ministers and parliamentarians are also involved with construction projects.
Information Minister Abdirahman Omar Osman would like the international community to invest directly in the budget so as to prevent future hunger crises. "We are absolutely dependent on the trust of our international partners. If we don't get money to build the state, we can't be accused of corruption," he said.
Osman also suggests that international aid isn't free of corruption. "The flow of money through the many multilateral sources should also be reviewed. But the focus is always on corruption on the Somali side."
Change takes time
The last major famine in Somalia in 2011 killed more than 250.000 people. During this crisis aid was provided too late, because the world had virtually forgotten about Somalia. This year, large relief organizations were on the ground, with personnel, cash and food reserves.
"We have spent four billion dollars on humanitarian aid since 2011," says UN emergency relief coordinator Peter de Clercq.
However, "international emergency aid cannot replace a functioning state", he warns.
"Think about where we would be today if we had invested four billion dollars in reconstructing Somalia? I am not saying that we should stop humanitarian aid. But we urgently have to invest in development," de Clercq emphasizes.
He thinks in decades. "If we lack strategic patience, we won't succeed in Somalia."