LEKU, Ethiopia - The eyes of the boy who is crumpled on the plastic mattress tell his story. They float aimlessly in their sockets, as if just focusing them would expend his last drop of energy. His head bobs like a doll's. His arms and legs are swollen, a sign, the doctors here say, that in these days of hunger his body has no choice but to feed on itself. His medical chart lists his weight in blue ink: 10.1 kilograms - about 22 pounds - a healthy size if he were a 1-year-old. But this boy - Muse is his name - is 5.
He is the latest arrival on a recent afternoon at a feeding center in the Great Rift Valley, one of the regions hit hardest in a food crisis sweeping Ethiopia.
This valley, where lakes teem with fish and flocks of flamingoes wheel in the sky, did not struggle with hunger in the past. But this year, few areas of this country have been left untouched by a food crisis far worse than the famine of 1984, when a million people died. That year about 5 million people went hungry. Today more than 13 million people, one in five Ethiopians, are in danger of starving.
No one is expecting deaths on the scale of 1984. This year's disaster was forecast months ago, allowing millions of tons of food aid to be distributed. Still, new pockets of starvation like those in the Great Rift Valley are being discovered every month.
That this tragedy is unfolding in Africa is not surprising. Though many developing countries elsewhere in the world, notably China and India, have solved chronic bouts with famine, sub-Saharan Africa continues to battle with deep-seated food insecurity and, in the worst years, the threat of widespread death from malnutrition.
More than 40 million people in sub-Saharan Africa are struggling this year with starvation, according to the World Food Program. The United Nations Food and Agriculture Organization says 23 countries in the region face food emergencies, among them Democratic Republic of Congo, Liberia, Somalia, Sudan (nations where civil strife is to blame); Eritrea, Kenya, Madagascar and Tanzania (where the problems are caused by drought); and Zimbabwe (a combination of economic disruption and drought).
Ethiopia is almost in a category of its own. Two-thirds of its children have some kind of deficiency as a result of chronic malnutrition. More than 80 percent of the people are subsistence farmers shackled in deep poverty, surviving by the whims of the weather.
Year after year, millions of dollars in food aid and development projects have been pumped into the country, but still it cannot feed itself. It's no longer a question of waiting for good weather or good harvests. Something deeper is broken in Ethiopia, and no one has figured out how to fix it.
"Even in good years there are 4 [million] to 5 million people who cannot feed themselves," says Sisay Tadesse, a spokesman for Ethiopia's Disaster Prevention and Preparedness Commission, the government agency that oversees relief efforts. "We have been calling for international aid. It embarrasses us that we are in this situation."
The food crisis is being blamed on a severe drought that has shriveled crops, starving people and livestock. But it is wrong to view Ethiopia's problems as solely weather-related.
The popular image of starvation or, in its worst form, famine, is that it is a sudden, catastrophic event, caused by drought or war. Aid organizations and governments then marshal their resources to come to the rescue. Lives are saved, and when the rains fall or peace is restored, the victims of hunger recover and return to their normal lives.
But the causes run much deeper and in the end cannot be solved with a change in weather or donations of food. The reason Ethiopia is unable to feed itself is tied to countless events and circumstances, some natural, others man-made.
"It's a lack of food, a lack of clean water, a lack of medical facilities, a lack of proper nutrition. It's deep poverty. It's a problem of marketing food," says Wagdi Othman, a spokesman for the U.N. World Food Program office in Addis Ababa, the capital. "It's a whole combination of crises."
After the famine of 1984, aid agencies thought they could end hunger here. Ethiopia became one of the world's most studied cases of food insecurity. Aid agencies developed better ways to forecast food shortages, distribute food aid, measure nutrition and poverty levels and understand many of the forces that contribute to hunger, including destitution, overpopulation, climatic changes, erosion and poor roads.
But hunger persists, and for much of the country, circumstances have not improved since 1984. Most Ethiopians are poorer, sicker and experiencing hunger and malnutrition more frequently and in greater numbers. As this year's disaster is averted, warnings are heard that millions of Ethiopians will probably need food assistance next year.
Ephrem Emru, an Ethiopian representative of Save the Children, says of his homeland, "They are at the verge of disaster all of the time."