DADAAB, Kenya - Wardo Mohamud Yusuf walked for two weeks with one child on her back when her 4-year-old son collapsed at her side.
The 29-year-old asked the families she was traveling with for help, but they continued on their way. Then she had to make a choice no parent should have to make. Yusuf left her 4-year-old behind.
Now at a refugee camp in Kenya, Yusuf says she is reliving the pain of abandoning her son.
Parents fleeing Somalia's devastating famine are having to make unimaginably cruel choices: Which children have the best chance to survive when food and water run low? Who should be left behind?
The U.S. estimates that more than 29,000 Somali children under age 5 have died in the country's famine the last three months.
At the Kakuma Mission Hospital in northern Kenya, an incident between two mothers illustrates the growing desperation among refugees as a famine in neighboring Somalia that has killed tens of thousands draws an international aid effort.
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.
At least five people are reported to have died 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, 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.
In the nearly two weeks since little Lokol has been on the treatment, she's gained almost a quarter of a pound but has a long way to go before she reaches the weight she should be 33 pounds, 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."