Nasteha Jana Mohamed, 16, holds her baby girl, Anfa Habib Mohamedís, inside Benadir Hospital in Mogadishu. Anfa is 3 months old and weighs only 5.5 lbs. She is suffering from severe malnutrition. (Sudarsan Raghavan/THE WASHINGTON POST)

Anfa Habib Mohamed’s skin is leathery and wrinkled, her face as gaunt as an old woman’s. Her cloudy eyes stare blankly at the ceiling as flies land on her forehead. Every few seconds, she moves her thin, tiny fingers, the only visible sign that she is alive.

Anfa is 3 months old. On her medical form, she weighs 5.5 pounds, but even that seems generous. Her cheeks are more bone than flesh. Her mother admits that her child is closer to death than to life. “I am afraid,” said Natesha Jana Mohamed, 16, holding her still child in her lap. “If she remains like this, she will die.”

Inside this overcrowded, understaffed hospital, evidence of Somalia’s worst famine in two decades is all around. Turn left, and a baby suffering from severe malnutrition is listless, too weak to cry. Turn right, and a baby’s face is crisscrossed with white tape to hold the feeding tube slipped into its small nostrils.

Then look a few steps away at the baby with the peeling skin, suffering not only from severe malnutrition but also measles and malaria. Hunger warps the body — along with the entire immune system.

The scenes at Banadir Hospital reflect the immense challenge facing this Horn of Africa nation, already besieged by multiple woes, from civil war to radical Islamist militants to a weak transitional government incapable of governing effectively, despite massive support from the United States and its allies.

This week, the scale of the challenge came into sharper focus: The United Nations declared that Somalia’s famine has spread to a sixth region and warned that at least 750,000 people are at risk of dying in the next four months if aid efforts are not stepped up. Tens of thousands have died, U.N. officials say. Most are children.

Searching out aid

The center of the crisis is in southern Somalia. Tens of thousands of people have trekked for hundreds of miles to reach refugee camps in neighboring Kenya and Ethiopia. Thousands more have arrived here in Mogadishu, settling down in 188 makeshift settlements around the capital city. They are the fortunate ones. Al-Shabab, the al-Qaeda-linked militia that controls large swaths of southern Somalia, has prevented many people from leaving famine-stricken areas, U.N. officials say.

For two years, Natesha, Anfa’s mother, lived as a refugee in the Afgooye Corridor, a stretch of road northwest of Mogadishu that houses large settlements of displaced people. She had escaped civil war. Then came a drought, and by July, a month after Anfa’s birth, the United Nations declared a famine. But as the crisis grew, al-Shabab barred humanitarian aid from entering Afgooye, as it has in other areas it controls.

Anfa was sick from the day she was born, Natesha said. And with each passing day, her frail body deteriorated. On Monday, with Anfa virtually motionless, Natesha cradled her in her arms and took a minibus to the capital. They left early to avoid al-Shabab fighters and arrived at the hospital at 9 a.m.

By 11:45, they had yet to see a doctor.

Anfa moved her tiny head and turned to reach her mother’s breast. But even that effort was a struggle, and soon Anfa gave up. Even if she had the energy, disappointment lay ahead.

“I am not even getting breast milk,” Natesha said.

In the next bed, Luley Ibrahim looked down at her 14-month-old daughter, Momine. But there was no response. Momine is blind, a result of severe malnutrition and vitamin deficiency. Sores peppered her skeletal head and protruding rib cage.

“We didn’t even know that a hospital existed,” said Ibrahim, looking down again at her baby. “I hope she will be able to see again.”

‘Hard to stabilize’

The hallway of the children’s ward was crowded with mothers carrying their sick babies. Some were so weak that they dangled like rag dolls. Many were dehydrated. Most suffered from severe malnutrition, diarrhea and diseases such as measles, malaria and meningitis.

Yasmina Hiller, a youthful German nurse, examined the babies, writing down their weights and other vital statistics. She had been at the hospital for 10 days. During that time, she had seen two to four babies die every day, she said.

Hiller and a medical student were the only ones monitoring 70 children in the ward.

“It’s really hard to stabilize them,” said Hiller, who has also volunteered in other African war zones, including Liberia and Angola. “They need milk, and they also need water. But you can’t overload them. So it’s really a risk.”

Most children, she said, seesaw between life and death. One day, a baby appears to improve; two days later, she’s near death. Even those who grow strong enough to leave the hospital often struggle with weight and diseases within weeks, said Hiller, visibly frustrated at the helplessness.

Duniya Mohamed Abdi, 10, lay sprawled on a nearby table.

She is epileptic. With so many famine-related cases, the hospital had neither the medicines nor the manpower to assist with her condition. She had been turned away before. But Duniya was now also suffering from hunger.

“The doctor said we can’t do anything, but we could admit her here for five days to treat her for malnutrition,” said Ali Mohamed, a neighbor.

A few minutes later, Hiller took two journalists downstairs to the intensive care unit. Steps away from the door, she spoke into her walkie-talkie to a co-worker to get permission to enter. She was told to stop.

“The baby is dying,” Hiller said. “We can’t go inside.”