Children wait to receive free food prepared by residents and volunteers in Caracas on Sept. 17. (Henry Romero/Reuters)

The last thing Susana Raffalli ever expected was to end up working back home in Venezuela. Over a three-decade career, Raffalli worked with desperately hungry people everywhere from tsunami-hit Indonesia to Pakistan to the refugee camps of southern Algeria. A nutritionist by training and humanitarian by calling, she participated in the Oxfam experts groups that brought statistical rigor to such emotionally charged terms as “hunger crisis” and “famine.” Now she’s back in Caracas, her home town, applying a lifetime’s expertise in a context that never ought to have called for it.

“People come here and see all these highways and skyscrapers and they just can’t believe there could be a hunger crisis here,” she tells me over the phone from Caracas. She tells me it was hard for her, too, to believe, at first. But then, as head of the Catholic charity Caritas’s response to the hunger crisis in Venezuela, she went into the field and started applying the monitoring mechanisms humanitarians use all around the world.

What she found was shocking. Caritas constructed a sample of more than two dozen at-risk areas in the poorest parishes of four Venezuelan states and started weighing children under 5 years old. This allows Caritas to measure “global acute malnutrition” — the key mechanism humanitarians use to assign numbers to the severity of hunger. In October, 8.9 percent of the children they measured faced either moderate or severe acute malnutrition. The number was high, and it has kept rising. By April, 11.4 percent of of children in vulnerable areas were experiencing acute malnutrition — well above the 10 percent threshold humanitarian agencies use to declare a food crisis.

More and more, Raffalli is finding households pursuing the kind of emergency adaptation strategies usually associated with famines in war-torn  countries. Sixty-three percent report turning to “unusual foods,” 70 percent report that they’ve stopped consuming types of food they consider important, and 85 percent of families in at-risk areas report they are eating less. In 57 percent of households in at-risk areas, someone in the family has reduced essential food intake so others could eat. Forty-four percent report going one whole day without eating at all. Overall, 34 percent of families are now resorting to at least one emergency coping strategy — a sign of acute food insecurity– such as selling productive assets to buy food, reducing essential expenditures, eating from garbage bins, sending a child to beg for food, or sending a family member to live elsewhere to relieve pressure on food stocks.

Out on the front lines, the ideological debates pitting the socialist government against a hardening hemispheric consensus can hardly be heard over the din of rumbling bellies.

Caritas finds people are eating a less varied diet — falling back on cheaper, less nutritious food to make due. As recently as December, 47 percent of households could afford to eat eggs; now just 38 percent can. Meat and poultry were on the menu for 41 percent of these families at the end of last year; just 33 percent now. Even margarine and cooking oil are now out of reach for many: Sixty-four percent were using these things in December, but just 34 percent are now. The household food security survey showed that people have been pushed to the extreme of having tubers as their main staple food: In Venezuela’s tropical climate, tubers and fruits are the only food items that survived the looting of the food industries by the state. Tubers have been buffering the reduction of intake of high-value foods such as meat, eggs, milk and vegetables.

For Raffalli, the numbers speak for themselves. However much oil Venezuela may have under the ground, its image as a middle-income country is out of step with the realities that families face on the ground.

Which is why, through Caritas, Raffalli is now implementing the same kind of humanitarian assistance program for malnourished children in Venezuela she once helped set up in postwar Angola in 2005, and in the aftermath of a severe drought and political crisis in Burma. But facing a government that refuses to accept there is a humanitarian crisis makes her work all the more daunting. So far, Caritas has been able to reach kids in just 32 parishes, helping feed 1,575 children directly and keeping an early-warning system that could allow humanitarian responses relevant to the scale and nature of the crisis.

That’s the tip of the iceberg: Much of the rest of the country is just as hungry. Venezuela needs serious and sustained humanitarian aid to stem the current deaths and prevent an entire generation of children from being stunted. But a government that consistently refuses to acknowledge this reality has stubbornly resisted declaring a humanitarian emergency and accepting the aid much of the world — including the United States — is offering.

As the rainy season approaches, and with it a seasonal upsurge in infectious diseases, Raffalli is especially concerned: Malnourished children often struggle to fight off infections that better-fed children can breeze through.

“If you’d told me 10 years ago that I’d end up back home doing the same work I used to do in Africa or in South Asia after a disaster, I never would’ve believed you,” Raffalli tells me. That, though, is Venezuela today.