The daily death rate in this country's largest refugee camp outpaces the death rate in any of the more widely publicized famine camps of Ethiopia.
A senior United Nations official warns of a "very alarming situation" in which thousands of refugee children will die unless there are major new commitments of food.
Somali health officials complain that they are unable to stamp out cholera because neighboring Ethiopia makes no effort to prevent carriers of the infectious disease from wandering across the desert to Somali refugee camps.
Still, the purveyors of all this bad news say no one is paying much attention.
They claim that the hunger, disease and death spawned by a new flood of Ethiopian refugees into Somalia are being ignored amid an international stampede to move food and money into Ethiopia and Sudan.
"We feel there is a very compelling and increasingly severe crisis here. But we have to fight harder and harder to get any attention," says Gary Troeller, deputy director of the Somali office of the United Nations High Commissioner for Refugees (UNHCR).
In the past year, about 150,000 destitute Ethiopians -- most of them nomads and livestock raisers from the Ogaden desert -- have walked east into Somalia. Some carried cholera with them, and in late March an epidemic broke out at a receiving center in northwest Somalia.
In one week at Gannet camp, located just outside the city of Hargeysa, 683 persons died. Somali health officials say cholera has killed 1,262 people this year. Most were new arrivals from Ethiopia.
The flood of refugees has come during a year in which the UNHCR cut back funding for Somalia from $39 million to $36 million.
Doctors and nurses at the Gannet camp report that the new arrivals have depleted Somalia's supply of refugee food. Rations at Gannet, which feeds about 60,000 people daily, have been cut by one-fifth, to less than what is recommended to sustain body weight, Troeller said.
An average of 19 people die at the camp each day, he said. Most die from diseases related to malnutrition, and most are children under age 5.
Gannet's death rate exceeds rates reported at the major famine camps in Ethiopia, where death rates in June were at less than 10 per day.
"The medical teams can help control infectious diseases like cholera, but we cannot prevent most deaths from malnutrition without food," wrote doctors at Gannet in a letter sent to the UNHCR in Somalia.
Western diplomats in Mogadishu, the Somali capital, say that one reason for the relative lack of world interest in Somalia is that its refugee problems are old hat.
Ever since the 1977-78 Ethiopian-Somali war chased nearly 1 million nomads out of the Ogaden into Somalia, this impoverished country of sand, camels and 4.6 million citizens has been making appeals for more money to assist refugees. More than 30 refugee camps, all of them funded and fed by international donations, have operated here for nearly six years.
"The attention of the world has shifted away from Somalia and its refugees just as it shifted away from Cambodia in 1978 and 1979," said one western diplomat here. "It is the way the West works. We can only focus on one crisis at a time."
Somalia's refugee problems appear to be dwarfed by those of Ethiopia and Sudan. In Ethiopia, an estimated 8 million people are threatened with starvation -- nearly twice the entire population of Somalia. In Sudan, officials at the U.N. Children's Fund say a million children may die this year of famine; this is more than the entire refugee population of Somalia.
Several diplomats and aid officials noted that some western donors -- especially the United States -- do not trust the Somali government's figures.
"Let's say we have great skepticism," said one western diplomat. "We didn't believe them when they told us there were 700,000 refugees here a 1982 Somali figure claimed until the recent influx . And we don't believe there are 150,000 more now."
No scientific count of refugees has been conducted in Somalia in the past three years. Prior to the recent influx of refugees, the Somali government did not even acknowledge that tens of thousands of Ethiopians had left camps here in 1983 and 1984 to return to their homes.
Some western diplomats, who refuse to speak on the record, claim that refugees are not screened properly and that opportunist Somali nomads are queuing up alongside the refugees in the camps for free food.
In Somalia, one of the poorest countries in the world, life in refugee camps is often better than in the open desert, where nearly 60 percent of Somalis live. A recent Children's Fund report on women and children in Somalia put the infant mortality rate in the camps at well below the national average, which is about 180 per 1,000 live births. This is the fourth highest infant mortality rate in the world, according to the World Bank.
The Children's Fund report also said that women in the camps were far more likely to survive childbirth than they would in the nomads' camps.
"We think these camps have been incorporated into the culture of the nomadic people," said a western diplomat. "They move back and forth beween these camps. It is becoming a regular part of their lives, and we don't want to support that."
Troeller, the UNHCR official, admits, "We don't know how many are drought victims, how many are political refugees. We do screen out the locals, though."
He adds, however, that new arrivials from Ethiopia are continuing to come into Somalia at a rate of 300 to 400 a day, many carrying cholera. They must be screened, he said, and they must be fed.
"The generosity that the world showed Somalia this year in helping get a handle on cholera was very impressive," Troeller said, referring to an international airlift of cholera medicine and sanitation experts.
"But now, despite the arguments over the numbers, we need food," Troeller said.