Normally, after consuming the therapeutic product for a few days the child's condition starts to improve. But in many instances the UN Refugee Agency finds the child is not getting better. And other children suffering from severe acute malnutrition who would normally respond well to the nutrient-dense paste aren't getting better either. It's because they're only eating a fraction of the prescribed dose of two to three sachets a day. Their families are so hungry they're sharing the paste among themselves.

"I've worked in the humanitarian field for more than 16 years now and [this] level of malnutrition and desperation I've not seen many times before," said my UNHCR colleague Johannes Zech, whose role involves looking after Somali refugees who've crossed the border into the south-east corner of Ethiopia.

In South Sudan, cuts to rations in refugee camps are forcing people to venture into the bush in search of food, sometimes returning with little more than leaves to cook for their families.

"Some of the leaves are not edible," UNHCR's Deputy Representative in South Sudan, Juliette Murekeyisoni, told me.

"Four children have died from eating them."

These are just some of the heartbreaking stories I've been hearing from UNHCR colleagues working across the region amid a deepening crisis.

The Horn of Africa is facing the worst drought in 40 years. It's the result of four consecutive failed rainy seasons and influenced by climate change. Now a fifth rainy season, due this month, is also forecast to fail.

"The people who have contributed the least to climate change are paying the greatest cost," Johannes Zech said.

Many in this part of the world rely on the land for their survival. Like Australian farmers, herders and pastoralists in the horn are incredibly resilient. They have adapted to the harsh arid climates of the region. They have endured climate stresses before.

But the current prolonged drought combined with skyrocketing food costs from the Ukraine war, and instability from regional conflict have pushed many to breaking point.

More than 20 million people are facing extreme hunger across the region, with Somalia, Ethiopia, and Kenya hardest hit.

As livestock die, waterways dry up, and food becomes scarce, families have been left with no choice but to leave their homes in search of food, water, and pasture. In some cases, they have walked hundreds of kilometres over scorched lands with animals and young children to reach the safety of camps for the displaced.

In these camps, humanitarian organisations like the UN Refugee Agency and World Food Programme are working tirelessly to keep hundreds of thousands of people alive with shelter, water, food and other aid. But funding shortfalls and rising costs have forced aid agencies to reduce food and water rations for families.

Sadly, the crisis is expected to get worse.

Famine is now projected in parts of Somalia in the next few months. While many countries face food security crises, only rarely do the conditions meet the humanitarian community's formal criteria for famine. During the last famine in Somalia in 2011, 250,000 people died and half were children.

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On a recent visit to a hospital in Somalia, the UN's Under-Secretary-General for Humanitarian Affairs Martin Griffiths found that the children could not smile or cry.

"And as we discovered when we left, we had the good fortune to hear a child cry, and we were told that when a child cries, there is a chance of survival. Children who don't cry are the ones we need to worry about," he said.

These images of emaciated children may take you back to 1985 when famine in Ethiopia was propelled on to the world stage by the Live Aid fundraising concert, organised by Bob Geldof.

Today, it is a challenge to get anyone to notice.

As crises around the world have dominated the headlines over the past 12 months, from COVID-19 to the Ukraine war to recent floods in Pakistan, some may ask whether the world is experiencing disaster fatigue.

What I have seen in Australia tells a different story.

I have seen continued generosity and compassion from Australians. Our emergency appeals following the takeover of Kabul last year and invasion of Ukraine earlier this year raised record amounts. But unlike those crises, Africa has not received the same media coverage. My plea to you now is to not forget these people. The farmers whose cattle are now dry bones in an arid landscape. The mothers who are watching disease take hold of their starving children. The people eating leaves to quench aching hunger.

We can all do something to help.