The United Nations said Tuesday it needs further safety guarantees from armed groups in Somalia if it is to help hundreds of thousands of people in need of emergency aid because of drought and conflict in the East African country.
Aid groups have struggled to reach many of those affected because armed groups banished them from large parts of southern Somalia starting in 2009.
With thousands of people now on the brink of starvation, Somalia's most dangerous militant group, al-Shabab, has promised aid groups limited access to areas under their control.
But the U.N. refugee agency, which has distributed aid to 90,000 people in the capital Mogadishu and in southwest Somalia in recent days, said this isn't enough.
"The situation we have for humanitarian workers inside Somalia at the moment is not what we want it to be," UNHCR spokesman Adrian Edwards told reporters in Geneva. "We do have a very minimal presence, and we have regular visits into the country, but we need significantly better access than we have at the moment to address an emergency of this scale."
The global body says over 11 million people in the region known as the Horn of Africa need emergency assistance after what is considered the worst drought in 60 years. Many have left their homes seeking help in large refugee camps in Kenya and Ethiopia, making it easier for aid groups to reach them but raising the prospect of disease epidemics from large population movements and poor sanitation.
In Washington, Reuben Brigety, who oversees the State Department's refugee programs for Africa, said up to half of Somali refugees arriving at camps are suffering from acute malnutrition. He said that refugee flows of 3,200 a day could rise "still more dramatically" as hungry people seek assistance in neighboring Ethiopia and Kenya.
Brigety, who visited camps in those countries last week, praised their governments for pledging to keep their borders open. But he said donor nations must do more to deliver food and supplies inside Somalia.
So far, the U.N. has stopped short of calling the situation in East Africa a famine, though the formal conditions for it _ two deaths per 10,000 a day _ are present across at least parts of the border region between Somalia, Ethiopia and Kenya.
"If you look at what's going on on the ground, you look at the pictures, you listen to what everybody is saying, it's a very serious situation, whether you use that word or not," Emilia Casella, a spokeswoman for the World Food Program, told The Associated Press.
WFP has offices in four regions of Somalia from where it is trying to feed 1.5 million people, she said.
But the agency estimates that as many as 1 million people are in areas it can't currently access.
"Once we have the assurances of security and the ability to have full access to deliver and distribute and monitor, then we will be prepared to go back in," said Casella.
USAID's deputy administrator Don Steinberg said he would meet with aid officials from other wealthy governments on Wednesday in London to discuss what could be done to help.
Bradley Klapper contributed from Washington.