For a two-year-old child, Bishir Arab should be twice his weight, but severe malnutrition has seen his body weight plummet to just six kilogrammes.
Too exhausted to show any emotion, Bishir was one of many children hospitalised in Gode, some 75 km southwest of Denan, southeastern Ethiopia. From a handful of children initially brought in for treatment, the numbers have turned into a steady flow, overwhelming the two doctors at the hospital.
"We are starting to see more patients come in with drought-related illnesses and signs of severe malnutrition," said Zelalem Gizachew, one of the two doctors. "But we are very short of drugs and with only two doctors, any increase will be difficult to cope with."
He added that the use of dirty water meant diseases like measles and diarrhoea were also spreading in the area. These had exacerbated wasting among undernourished children.
"We have not received any help even though we have no food," said Bishir's mother Idil Arab, who trekked the 75 km to Gode Hospital from Denan. "We have been forgotten."
The area around Denan, a dry, dusty village in the extreme southeast some 1,400 km from the capital, Addis Ababa, is where the messengers of widespread hunger have made their first call.
The bones and rotting carcasses of cattle are its signposts, foretelling disaster.
"If there is no intervention, then we could be talking about the same disaster we had in 2000," said Abdullahi Ali Haji, the government's health officer for the area.
As many as 98,000 people died during a drought in Ethiopia in 2000, according to estimates by the Journal of the American Medical Association.
Effects of drought
Around Denan, the effects of that drought and its impact on communities are still visible. Some 10,000 people continue to live in a makeshift camp on the outskirts of the village, having moved there six years ago in search of food.
"The drought is already here. This is our warning that without immediate help...there will be deaths. We are still assessing the situation rather than making emergency interventions," Haji added. "We have to move quickly."
Although some aid is beginning to arrive in this remote region, local residents said it was too little, too late.
Aid workers said although urgent appeals for food, water and medicine had been made, often it took weeks, if not months, before the aid arrived.
Yet the widespread food shortage in Denan had announced itself before arriving in the area.
While land degradation, overcrowding and global warming have been blamed for the successive droughts that afflict Ethiopia's desolate Ogaden region, poor rains over the last nine years have left many families living on a knife edge.
This year the rains failed completely, leaving the area, whose landscape is ribbed and rutted like a crocodile's back, with dried riverbeds and sun-parched valleys.
Food prices have gone up by as much as 50 percent, while the value of livestock has plummeted, affecting mostly nomads, who rely on cattle, sheep, goats and camels for food and income.
With livestock deaths on the increase, many people have started migrating to nearby towns in search of aid. Some of those who have recently been displaced have walked 200 km into the Ogaden from across the borders of neighbouring Kenya and Somalia, where the situation is said to be worse.
In this area alone, about 1.75 million people - mainly nomads - need help, say aid workers.
The earth is baked hard, and little grows from it. Temperatures regularly rise above 38 degrees Celsius. Eddying pillars of dust whirl over the camel trains of nomads searching for food.
In good times it is one of the busiest caravan routes in Africa, as daily processions of camels packed with wares travel from Somalia to Ethiopia along the edge of the Rift Valley, their traders making tidy profits.
Unfortunately, an earlier crackdown by the authorities on smugglers, coupled with Saudi Arabia's continued ban on meat imports from the region out of fear of Rift Valley Fever, had already left many families without reliable incomes.
Urgent help needed
"Without urgent help the drought could spiral," said Bjorn Ljungqvist, the country director for the UN Children's Fund (UNICEF) in Ethiopia. "Urgent emergency intervention in the form of food, water, and vital medicines for women and children is needed to avert an impending disaster."
For this area alone, the UN needs US $6 million to help - and not just to avert hunger. In 2000, a fifth of all deaths of children under the age of five were measles-related. At the moment, almost half of the region's water wells are broken or unusable, according to UNICEF, and at least 637,000 people depend on emergency water supplies.
"The alarm has been raised in time but if we don't get the support we need, the results could be catastrophic. As ever, women and children will bear the brunt of this disaster," Ljungqvist said.
Ogaden, with a population of four million, has yet more problems.
Administratively, it is the weakest of Ethiopia's federal regions, with its huge area and sparse population. A long-running conflict between the government and a rebel secessionist group, the Ogaden National Liberation Front, has also severely hampered any real development in the region. In recent months the insecurity has taken a menacing turn, with trucks of food aid being attacked and in some cases burnt.
Violent clan disputes - a spill over from the feuding factions in neighbouring Somalia - have also deterred the work of aid workers in the region.
Hospitals are virtually non-existent and schools are too far for children to attend. Gode Hospital, for example, is the only such facility for a population of one million people.
"If the rains do not come things will get worse and we still do not know how we are going to cope until then," Ayan Abdi, a mother of two-month-old twins, said. "This is a bad time."
Weakened by hunger
So weakened by hunger that she is now unable to earn the $7 a month that she used to get from collecting firewood, Ayan has seen her breast milk dwindle to barely enough for one child - her daughter.
While her son, Niemo, has tightly stretched skin over his tiny skeletal frame, his twin sister, Asma, still retains some of the rounded features she was born with.
In a few days, perhaps a week at the most, Niemo could be dead, Ayan said, adding that it would not be the first time she had lost a child to hunger - three of her children died in the devastating drought of 2000.
The same region is once again among the worst affected by a new and potentially disastrous drought in the Horn.
Across the Horn of Africa, according to the UN Food and Agriculture Organization, some 11 million people are on the brink of starvation due to the extensive drought that has affected Djibouti, Ethiopia, Kenya and Somalia.
The rains are due in three months, but some forecasters are predicting they will be late - adding to Bishir and Niemo's woes.