Mothers in Akobo are struggling to feed their children
By Andrew Harding
BBC News, Akobo
Aid agencies are warning of an impending food emergency in South Sudan, where "unexpected and alarming" malnutrition rates in one region, devastated by drought and tribal conflict, have prompted an appeal for urgent extra funding.
Akobo, in the eastern region of Jonglei, is now the "hungriest place on earth," according to aid officials, after a new survey showed that 46% of children under five are malnourished - 15% severely so.
The town's crumbling, bullet-scarred hospital is treating some of the most serious cases.
A dozen painfully thin children lay on beds, some in obvious distress as their mothers tried to feed them.
The United Nations' senior humanitarian official in South Sudan called the malnutrition figures "astonishing
Visiting Akobo, Lise Grande said the levels of malnutrition were three times higher than the standard UN threshold for an emergency.
"If we're seeing these kinds of rates now we can only expect far worse in the coming months," she said, warning of a 50% short-fall in aid funding, and an urgent need to pre-position food supplies before seasonal rains cut off access to more than half of the region in the next few weeks.
Although the situation is clearly difficult, privately some local officials are warning against alarmism, pointing out that there is as yet no indication that more people are dying as a result of malnutrition.
It is not yet clear if this is because the weakest children were killed by violence in 2009, or because aid agencies - well established in the region - are already helping the worst affected.
"The situation is not good," said Bernadette Tata, a nurse in Akobo hospital. "But we can cope."
Conflict and drought
A few minutes earlier, a gaunt woman called Nadulchan had come into the hospital with her three-year-old son, Dwal.
She sat on a bed, trying to support his lolling head, as he appeared to drift out of consciousness.
"There's nothing to eat," she said quietly. "I lost two children in the fighting with the Murle [a local tribe]. I pray I don't lose this one."
Hunger is a familiar enemy across much of this vast, impoverished and insecure region.
The World Food Programme estimates that nearly half the population will need food aid at some point this year.
The situation in Akobo is simply the most extreme example.
A dramatic surge in ethnic conflict in 2009 prompted thousands of families to seek shelter in the town. Most remain too scared to return home.
That has coincided with a prolonged and devastating drought that has left people dependent on unusually expensive imports and on foreign aid.
"This is a very testing year," conceded Goi Jooyul Yol, the commissioner of Akobo county, who was sent here in 2009 to tackle the crisis following a series of massacres.
He said he had only received about a tenth of his expected budget from the government, and warned that a continuation of the drought would be "unbearable and unthinkable."
In recent months South Sudan's army, the SPLA, has been trying to disarm local tribesmen who have been stealing each other's cattle, and often abducting children.
Some 400 confiscated weapons - mostly AK47s - are being kept in a steel container at the army base outside Akobo.
"We've done some things to curb the violence," said Mr Yol.
"We hope for a less violent year, but the army and police were not adequate to control things.
The rule of law was not implemented
Hungry people will get a gun in order to get a cow to eat. It is a matter of survival."
Save the Children, one of the organisations already working in Akobo, warned of the challenges ahead.
Many teenage girls die in childbirth
"In a region where a 15-year-old girl is more likely to die in childbirth than she is to complete primary school, life for children
will remain tough for many years to come," said South Sudan director Kate Foster.
"We had expected to see some increase in malnutrition levels. The extent of the deterioration was, however, unexpected and alarming."
On the dusty outskirts of Akobo, families remain camped in makeshift shelters, waiting for food aid, rain and the opportunity to return to their villages.
Nyadir Muon, 40, said her family had fled their homes a year ago when they were attacked by members of a rival community, who abducted their children and stole cattle.
She condemned the government's disarmament campaign, saying it had left them defenceless against other groups that had retained their weapons.
In theory, these should be hopeful times for South Sudan.
After 21 years of civil war with the North, the region is due, in the coming weeks, to take part in the country's first democratic elections in a generation.
In January 2011, the South is widely expected to vote for full independence in a referendum guaranteed under the terms of Sudan's 2005 peace deal.
But Akobo's troubles give an indication of some of the enormous challenges now facing a turbulent, war-ravaged region.