The two mothers exchanged blows as they held their wailing infants in their arms after one of the women tried to cut in the long line for children to receive treatment for severe malnutrition.
The women faced off a second time after passing their children to onlookers amid the melee: The younger woman head-butted the other to the ground before hospital personnel intervened and separated them.
"She ordered me to move after she cut the line and I have been here since dawn. I could not let her," said one of the women who only identified herself as Chipure, a mother of eight children, who got a swollen lip from being head-butted.
The incident at the Kakuma Mission Hospital illustrates the growing desperation in northern Kenya, as a famine in neighboring Somalia that has killed tens of thousands draws an international aid effort. At least five people are reported to have died here in Kenya's Turkana region, one of the most remote and marginalized areas in the country, where people depend on herds of animals that are dying from the drought.
According to the U.N. children's agency, a little more than half of the population here consumes just one meal a day. The hunger crisis is so bad that families here are even sharing food supplements given to infants.
The temperature here can hit 104 degrees Fahrenheit (40 degrees Celsius), and 20 liters of water costs a third of John Ekidor's daily wage.
"The last time I took a bath was a week ago," said Ekidor, 33, who supports his family of eight by panning for gold. "Eating one meal a day is now a matter of chance."
At the Makutano Health Center, dozens of women line up to get their children a special peanut butter paste that is high in protein and carbohydrates.
Nyanyuduk Logiel, a 28-year-old mother of five, has brought her 3-year-old daughter Lokol back for follow-up care. The toddler is only about a third the weight she should be and can barely stand. She weighs only 12.35 pounds (5.6 kilograms).
In the nearly two weeks since little Lokol has been on the treatment, she's gained almost a quarter of a pound (100 grams) but has a long way to go before she reaches the weight she should be — 33 pounds (15 kilograms), says Jimmy Loree, the nurse in charge of the clinic.
Loree says the number of children being treated for acute malnutrition tripled from 21 to 68 in July, and he expects the figure will continue to rise.
"This year is really bad, it is really out of hand because if you see how people are living they have been depending on their animals that have been taken," Loree said.
School attendance is also down, from 200 children to 156 at one primary school, as families relocate in search of pasture and better grazing lands.
Droughts are common here, but over the last decade they have turned much more frequent. Before they occurred in five or 10-year cycles but now they are coming every two years — or even more frequently.
Dr. Joseph Epem, the medical officer in charge of largest government hospital in the region, says cattle rustling and border conflicts also have forced people living in areas where food can be grown to move to safer areas that are infertile.
He says his own family was forced to move from a fertile area near a river where they used to grow crops after their neighbor was killed. And last Friday, eight Turkana women were killed by Ethiopian Merille tribesmen in a dispute over land and pasture.
Epem says health officials must address the underlying issues fueling the crisis. Otherwise, they'll have to return with food aid again.
"We do it for three months — the rate (of malnutrition) comes down — and then once we pull out we go back again," he said. "It becomes like a vicious cycle."
The United Nations warned Wednesday that the famine in East Africa hasn't peaked and hundreds of thousands of people face imminent starvation and death without a massive global response.
U.N. deputy emergency relief coordinator Catherine Bragg appealed to the international community for $1.3 billion needed urgently to save lives.
"Every day counts," she told the U.N. Security Council. "We believe that tens of thousands have already died. Hundreds of thousands face imminent starvation and death. We can act to prevent further loss of life and ensure the survival of those who are on the brink of death."
Bragg's office, which coordinates U.N. humanitarian efforts, said the famine is expected to spread to all regions of south Somalia in the next four to six weeks unless further aid can be delivered. The global body says it has received $1.1 billion, just 46 percent of the $2.4 billion requested from donor countries.
Bragg's appeal came as a U.N. food agency official warned that the number of people fleeing famine-hit areas of Somalia is likely to rise dramatically and could overwhelm international aid efforts in the Horn of Africa.
Luca Alinovi, the Food and Agriculture Organization's representative in Kenya, warned that the situation could become "simply unbearable" in the coming weeks if Somalis continue to abandon their homes in southern and central parts of the country — which are mainly under control of al-Shabab Islamist extremists — in search of food.
The United Nations estimates over 11 million people across East Africa need food aid because of a long-running drought exacerbated by al-Shabab's refusal to allow many humanitarian organizations to deliver aid in areas it controls, including the U.N. World Food Program, the world's major aid provider.
According to the U.N.'s Food Security and Nutrition Analysis Unit, Bragg said, "the current situation represents the most severe humanitarian crisis in the world today and Africa's worst food security crisis since Somalia's 1991-92 famine."
"We have not yet seen the peak of the crisis," she warned, citing high levels of severe malnutrition and deaths of children under age 5, combined with increasing cereal prices and a dry harvest season.
The Food and Agriculture Organization reported Wednesday that cereal prices in East Africa reached new peaks in several countries last month, worsening the already dramatic situation for millions of hungry people. The FAO said prices of milk also were at record or very high levels in most of the region.
Food prices have been driven higher by drought-plagued harvests and sharp increases in fuel and transport costs, according to the Rome-based agency.
In the past two months some 220,000 people have fled toward the Somali capital of Mogadishu and across the borders to Kenya and Ethiopia, where refugee camps are straining under the pressure of new arrivals. Almost 1 million people are displaced elsewhere in Somalia, the U.N. estimates.
"The possibility is basically having everybody who lives in that (famine) area moving out, which would be a disaster," FAO's Alinovi said, adding that transportation costs have doubled in recent months — evidence that there is growing pressure to leave.
Alinovi said FAO was working to prevent Somalis from abandoning their drought-stricken farms by paying them cash for small jobs, thus allowing people to remain. Once people leave their farms, they become dependent on aid for a very long time, he said.
Cash payments have been controversial in Somalia, because of the possibility that money might end up in the hands of militant groups like al-Shabab, who are fighting the weak central government in Mogadishu.
"It is a risk that can be handled," Alinovi said of the cash payments, warning that the alternative could be a sharp rise in the number fleeing. "If this becomes a massive number, like hundreds of thousands of people moving out, then this simple problem will be very difficult to bear."
Bragg told the Security Council that in areas under control of al-Shabab, the U.N. and its partners continue to negotiate for access.
In recent weeks, she said, some progress was made to scale up emergency operations by the International Committee of the Red Cross in central and southern Somalia. It is the only organization allowed to conduct food distribution in al-Shabab areas.
The U.N. children's agency, UNICEF, is also boosting its supplies for feeding centers, she said.
Since July, Bragg said, food is also being delivered to two newly accessible areas in the Gedo region.
But she said 3.7 million Somalis "are in crisis," 2.8 million of them in south central Somalia, and 3.2 million need "immediate, lifesaving assistance" including 1.25 million children.
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