When I ask Bagey Ali when the last rain fell in Qansax Dheere, he laughs at the idea, then struggles to remember. “Two years,” he says. “Maybe four.” Southern Somalia is part of the Sahel, the band of dry land that runs across Africa below the Sahara. Half a century ago, rainfall was sparse, but droughts occurred only once a decade. Today they come every two years, and in areas where El Niño and La Niña disrupt the seasons, there haven’t been good rains for 10 years. This is climate change now — severe and lethal. The U.N. Food and Agriculture Organization says this year’s drought is the worst since 1950-51, and the compound effect of successive rain failures means an area the size of France has become desert in 50 years.

But drought just sets the conditions for famine; only man ensures it. The southern U.S. is in drought, but Americans aren’t starving. Why? Because Americans have enough government and wealth. Likewise, one reason we are not seeing a repeat of the 1984 Ethiopian famine, in which a million people died, is that much of East Africa has progressed since then. Also, aid workers are now better at saving lives. An early-warning system first predicted East African food shortages 11 months ago, food aid has become more sophisticated and includes medicines and high-protein nut pastes, and improved disaster mitigation is matched by better prevention. Schemes like the U.S.’s $3.5 billion three-year program Feed the Future push ever more money into projects such as irrigation and food warehouses that raise people’s ability to feed themselves. “It’s really important we understand the progress even in the face of this tragedy,” says Nancy Lindborg, who is leading USAID’s famine response.

Such progress only throws the disaster in Somalia into sharper relief, however. Because if it is humans who produce or prevent famine, who made Somalia’s?

The big difference between Somalia and the rest of East Africa is war. Somalis have been fighting one another and have lived without a central government for 20 years. Perhaps a million people have died. One symptom of this lawlessness is piracy. Another is the rise of Islamists. What began as a fight between clan warlords became, in its second decade, a struggle between warlords and militants demanding the imposition of strict Shari’a. The more extreme Islamists then formed al-Shabab, or “the Youth.” For four years, al-Shabab has battled the official Transitional Federal Government (TFG).

The U.S. is the key international player. Since the 1993 battle known as Black Hawk Down, when 18 U.S. troops died during an intervention to support a U.N. mission in an earlier famine and the bodies of two were dragged through the streets, few Americans have set foot in Mogadishu. But Washington pays close attention. Osama bin Laden first shot to the top of the CIA’s danger list not on 9/11 but on Aug. 7, 1998, when his Somalia-based unit blew up U.S. embassies in Nairobi and Dar es Salaam, Tanzania, killing 230 people. When al-Shabab allied with al-Qaeda, it too found itself in American crosshairs.

The U.S. strikes when it can. When Ethiopia invaded Somalia in late 2006 to topple the Islamist government, U.S. Special Operations troops went with them and detained about 20 al-Qaeda suspects. Washington has also assassinated several Islamist leaders in Somalia, using Predator drones, cruise missiles launched from warships in the Indian Ocean and, once, a helicopter gunship. Those efforts are assisted by a CIA station in Mogadishu and U.S.-funded mercenary operations. Also, Washington bankrolls the unelected TFG, which is perhaps best understood as a U.S. attempt to create a Somali leadership whose authority does not depend solely on firepower.

In spite of such labors, al-Shabab was ascendant a year ago. It seemed set to take Mogadishu and announced its international debut in July 2010 with twin suicide-bomber attacks in Kampala, Uganda, which killed 76 people.

Aid as a Weapon
By then another U.S. initiative was starting to bite. In 2008 the U.S. State Department listed al-Shabab as a foreign terrorist organization, making aiding or abetting it a serious crime. Al-Shabab was stealing aid to feed itself and to sell. Theft of aid is a routine occurrence, but when al-Shabab was designated as a terrorist group, it meant that U.S. officials and foreign aid workers whose actions benefited al-Shabab, even unwittingly, would be penalized. By late 2009 the U.S. was withholding about $50 million in food aid from al-Shabab’s territory in southern Somalia, saying it had no legal alternative. By early 2010 the U.S. was in a standoff with aid workers, requiring them to refuse to pay the tolls al-Shabab demanded if they wanted U.S. funding. For its part, al-Shabab expelled the World Food Programme (WFP) in January 2010, saying food aid created dependence and that the organization was an American proxy: 60% of the WFP’s food is from the U.S. Al-Shabab also claimed WFP contractors were corrupt; a Western investigator tasked with probing the WFP’s operations in southern Somalia tells TIME many contractors were indeed skimming anywhere from 25% to 65% of aid to sell in the market.

In effect, southern Somalia was largely without aid and lacked a reliable distribution network through which to move emergency supplies in the event of a disaster. Warning of a crisis, Mark Bowden, U.N. humanitarian coordinator for Somalia, accused the U.S. of fighting its war with aid. “We’re no longer involved in a discussion about the practicalities of delivering humanitarian assistance with proper safeguards,” he told reporters in February 2010. It had become “an issue of where assistance can be provided on political grounds.”

On its narrow terms, U.S. strategy succeeded. Al-Shabab has been severely weakened by a combination of famine and the loss of Middle Eastern funding since the political turmoil there. The group has suffered desertions and bloody internal divisions over whether to accept aid. On Aug. 6, it withdrew from Mogadishu.

But what impoverished al-Shabab’s few thousand fighters also helped push a few million Somalis to the brink of starvation. The same areas ruled by al-Shabab are those now blighted by famine. On the ground in those regions are the International Committee of the Red Cross, several Islamic charities, a handful of Médecins sans Frontières workers and local UNICEF contractors. That’s it. The U.N. says just 20% of the 2.8 million southern Somalis in need are being reached. The WFP, the giant of famine relief whose slogan is “fighting hunger worldwide,” is absent.

Asked whether the U.S. inadvertently contributed to the famine, Bruce Wharton, U.S. Deputy Assistant Secretary of State for African Affairs, chooses his words carefully. “U.S. sanctions against al-Shabab do not and have never prohibited the delivery of assistance to Somalia, including those areas under de facto control of al-Shabab,” he says. While Wharton is technically correct, the practical effect of U.S. sanctions has been, precisely, to block aid to southern Somalia. That’s something the U.S. implicitly acknowledged in early August when it felt the need to issue new guidance to humanitarians, which, Wharton says, “should help clarify that aid workers who are partnering with the U.S. to help save lives under difficult and dangerous conditions are not in conflict with U.S. laws and regulations.”

Despite that clarification, restrictions still apply: Wharton says there are “risk-mitigation procedures, risk-based assessments and special conditions for our agreements … to avoid the diversion of humanitarian funds to al-Shabab.” Tony Burns, operations director for the Somali aid group Saacid, says that on the ground, those conditions are resulting in a continuation of the aid block. By mid-August, WFP staff confirmed that the agency had no access to al-Shabab areas — and that even if that were ever allowed, food distribution would take weeks to organize.

Some aid workers openly accuse the U.S. of causing the famine. “The famine is proof of U.S. success,” says Burns. Washington’s allies in the TFG aren’t shy, either, about hailing the strategic advantage the disaster gives them. The famine “is an opportunity to expand our reach,” TFG Prime Minister Abdiweli Mohamed Ali tells TIME. “The more weak [al-Shabab is], the more we reach.” A TFG military adviser confirmed that the TFG wanted no aid reaching southern Somalia until after it had defeated al-Shabab. Underlining the point, TFG commander General Yusuf Mohammed Siad, better known as Inda’ade, says, “We cannot take food to where they are. They have nothing, they cannot fight, and what we need to do now is clear them out. After that, we will take food there.”

Help Out of Reach
Slowly, hundreds of thousands of starving Somalis are realizing they may have trekked to Mogadishu only to die there instead. If there’s little aid in the famine areas, there’s also not enough outside them. Afraid for their safety, most Western aid agencies hole up in a fortified base next to the airport. Three weeks after the U.N. declared a famine and despite several aid flights arriving daily, food had yet to make it out of the airport to a camp just 100 m away. The WFP was distributing 85,000 hot meals a day through local groups, a small fraction of what Mogadishu’s 500,000 refugees needed. It tried a bulk food distribution at Badbaado, a camp of 30,000 people that sprang up in days on the edge of the city in July, but managed instead to spark a riot in which seven people died, nixing any similar efforts by other agencies. Meanwhile, looted WFP grain sacks are appearing in Mogadishu’s markets. At Banadir Hospital, Islamic Relief’s Mohamed is supplying medicine and staff and building a cholera isolation ward even though that was meant to be a job for the World Health Organization and UNICEF. “Where are they?” he asks.

Many in the aid world struggle to explain their poor performance. They should have been prepared. The U.N. has for years described Somalia as the world’s worst humanitarian crisis, and there were drought forecasts a year ago. “We are still trying to work out how we ended up here, what we missed, what we did wrong,” says Peter Hailey, senior nutrition manager at UNICEF. In a speech in Washington on Aug. 11, Shenggen Fan, director general of the International Food Policy Research Institute, said the aid world had overlooked just three things: a plan, action and political will. For the U.N. not to call an emergency appeal until July 20, by which time Europe and the U.S. were consumed with their debt crises, seems a particular mistake — and a reason the U.N. had by Aug. 24 only 58% of the $2.48 billion it says it needs. The funds raised are “dangerously inadequate,” said U.K. International Development Secretary Andrew Mitchell after visiting Mogadishu on Aug. 17.

That hasn’t stopped some aid groups from claiming a heroic success. The WFP broadcast a fundraising Twitter message on Aug. 9 proclaiming, “Airlifts launched to bring enough high-energy biscuits to Horn of Africa to feed 1.6 million people.” An accompanying press release clarified that the biscuits would feed 1.6 million people for a day and that the airlifts were from Nairobi to Mombasa, Kenya, not Mogadishu. On Aug. 10, Oxfam claimed it was “now reaching 880,000 people in Somalia.” A spokesman later admitted to TIME that there was no Oxfam staff in southern Somalia and that the figure of 880,000 was an estimate of the total beneficiaries of Oxfam-funded, locally implemented projects across all of Somalia, including latrines, water projects and aid vouchers outside the famine area. “I don’t think we’re distributing any food,” he added.

It’s all too much for Mogadishu’s mayor, Mahamud Nur: “How many people will die? The aid groups say they’re here, but where? It’s complete rubbish! Children are dying!”

The day I first visit Banadir’s 35-bed children’s ward, a 7-year-old child named Umar has just died. The next day two 1-year-olds follow, a tiny 18-month-old boy dies minutes after we arrive, and Abshir, a 9-year-old who looks 4, dies that evening. On repeat visits, I start recognizing children from the camps, now in sudden decline — vomiting, defecating, breathing shallowly, their eyes rolled back in their heads.

Banadir has lost its cemetery. Refugees have built huts and a makeshift classroom over the graves. As relatives scour Mogadishu for an unclaimed space big enough in which to lay Umar’s tiny body, I stand with his mother Khalima, 38, as she watches an orderly wash her son’s pin-thin body and wrap him in a white shroud. Overhead, unseen, a Predator drone hums. Then, in the graveyard school next door, the children start to sing.
With reporting by Mohamed Dahir / Mogadishu

This article originally appeared in the September 5, 2011 issue of TIME Europe.