Nancy Lindborg is the head of the Bureau for Democracy, Conflict and Humanitarian Assistance at the U.S. Agency for International Development. Her office is overseeing the U.S. humanitarian response to the drought in the Horn of Africa. Poor rains last fall and this spring have left more than 12 million people in need across four countries on the continent’s eastern tusk: Ethiopia, Kenya, Somalia and Djibouti.

Conflict-ridden Somalia has been worst affected. The United Nations has declared famine in five regions in central and southern Somalia, much of which is controlled by al-Shabab, an Islamist insurgent group that has at times banned Western aid groups and killed their staff members. More than half a million Somalis have fled to refugee camps in neighboring countries, where cholera and measles stalk amid the cramped living conditions.

The United States has provided $581.6 million in emergency aid this year, making it the biggest single donor to the relief effort. However, U.N. officials have warned of a funding shortfall. The famine is predicted to spread beyond its epicenter in Somalia in the coming months.

Lindborg spoke to The Washington Post from Nairobi. She had just touched down in Kenya’s capital and was due to visit emergency feeding centers and clean-water projects across the country in the coming days.

Can you tell us what you’re seeing on the ground as to how this crisis is affecting 12 million Africans?

We have a three-part emergency in the Horn right now. You have drought-affected communities in Ethi­o­pia, Kenya and northern Somalia. Then you have the famine in southern Somalia, where everything we’re hearing is very grave, with malnutrition rates of around 45 percent for children under 5. Then you have the refugee crisis, with around 2,000 to 3000 Somalians crossing every day into Ethiopia and Kenya.

It’s easy for the numbers to dissolve into abstract concepts. But it’s essential that, when we talk about 12 million people being affected, we understand that behind each one of those individuals is a story. When I was in Dadaab [a refugee camp in Kenya] in May, I met a woman who had brought her family of five on a three- to four-week trek to reach the camp, just to get food and assistance.

How is USAID spending its $581 million to combat the most urgent problem — southern Somalia’s famine?

In Somalia, we’re focused on three things, and we’ve spent over $92 million there. We’re providing immediate food assistance, with an emphasis on therapeutic foods [easily digestible food such as peanut paste or high-energy biscuits]. We’re also focused on health and sanitation, as we’re seeing the emergence of cholera and measles. Access to clean water — the ability to reduce mortality with that simple act is mind-boggling. Thirdly, we’re helping families to purchase food. In many parts of Somalia, there is actually some food in the marketplace. We have an $8 million food voucher program where we distribute vouchers that allow families to go to market and buy the food they need.

And how is USAID working across the other affected parts of the Horn?

In Kenya and Ethiopia, we are also working on programs that emphasize community resiliency. This involves things like helping people have healthier livestock. I heard someone say today that goats are their ready cash, cows are bank accounts, and camels are fixed assets. If you help people protect those savings, by giving their animals vaccinations or better fodder, they will get through this drought. It doesn’t sound like an emergency response, but it’s actually critically important. We’ve been investing in resiliency in the Horn for a number of years but specifically after the food price spike in 2008.

Al-Shabab announced last month that certain aid organizations could re-enter its territories in southern Somalia, partially reversing a blanket ban on such groups in 2009. Al-Shabab has also pulled out of Mogadishu, the capital. To what extent does this make your work easier?

We remain cautiously optimistic that access will be negotiated. And we’re learning that [al-Shabab] is not monolithic — there are different ways and systems where assistance can reach southern Somalia. But this is still one of the most insecure operating environments on the planet right now. Fourteen World Food Program workers were killed in 2008 just before the group was banned by al-Shabab. [Today] even Mogadishu remains extremely insecure. There has been some looting of food aid there. This isn’t Haiti or the Asian tsunami, where you had a flood of groups able to go in.

How do aid groups working in Somalia stop al-Shabab and other gangs from looting food aid?

Wet feeding [where food is prepared and served in individual portions on-site] is a way of ensuring that food is received by the individual who is the hungriest. There are a number of those initiatives in accessible areas. One of the ways in which many groups, including the Somali diaspora, is providing assistance is by helping families’ purchasing power. As I said, the emergency response is not just about providing food, but also about enabling increased [financial] access to food. . . . There’s an active trading culture in Somalia that brings food in from the region.

U.N. officials say a further $500 million in aid is needed across the Horn, and the crisis is predicted to worsen. Should the U.S. government and the public devote more money to this?

The United States has now given nearly $600 million, and the European Union countries have collectively come close to that. The United States is the leader in assisting the Horn. But we do fear that this will get worse before it gets better, and this is a bigger burden than what the traditional [Western] donors can shoulder. It needs assistance from non-traditional donors [such as the Arab world], which we’re starting to see.

With public donations, sudden disasters like a tsunami or earthquake are something that happen fast and are easy to understand. They always elicit a much more robust public response. This is a slow, complex emergency coming at a time when there are economic concerns at home.

What are the main challenges now, with the famine predicted to spread?

The concern now is what happens with the rains due in the fall. Because people and animals are already so weakened, rains could actually create additional emergency conditions — pneumonia or increasing sanitation problems. So, we could have another spike in mortality in the fall. Also, any time somebody is displaced, their vulnerability increases. A big priority for us is reaching people who are in southern Somalia and enabling them to not have to leave — to not get so weak and so vulnerable. That’s the huge focus now, coupled with assistance to the existing refugees.

In famines, death often comes in waves.