The displaced first began coming through Dolo, just a few miles from the Ethiopian border, in March. Now, the trickle has become a flood. The new arrivals clutch small bags of clothes and other meager possessions. Their children are thin, some emaciated. Almost every child appears small for his or her age. But they are the fortunate ones: They have survived their journeys, at least for now.

To get here, many have walked scores of miles, some more than a hundred. Almost everyone has passed bodies of mothers, children and the elderly — anyone too weakened by hunger to escape with their lives.

Tens of thousands of Somalis, mostly women and children, are on the move, fleeing the worst famine in a generation in this Horn of Africa nation. Resilient Somalis have endured two decades of civil war and two consecutive seasons of failed rains. Now, after their livestock and crops have died, and with their babies suffering from malnutrition and food prices skyrocketing, they have given up any pretense that they can survive on their own.

Any hope of the world helping them has also faded. Al-Shabab, the militia linked to al-Qaeda that rules large swaths of famine-stricken southern Somalia, has barred international aid agencies from delivering assistance to regions it controls. It has heavily taxed ordinary Somalis on food and other goods, exacerbating the crisis. In fact, the militia denies that a famine is taking place, disputing the United Nations’ contention that tens of thousands of Somalis, mostly children, have died because of it.

Yet nearly 170,000 Somalis have fled to already crowded refugee camps in neighboring Kenya and Ethiopia since January, according to U.N. figures released Monday. In Kenya, about 1,300 Somalis are arriving daily; an average of 1,700 are entering Ethiopia. Most emerge from their grueling journeys bearing scars that probably will not fade anytime soon.

Waiting in vain for help

Xukun Muhumed walked more than 130 miles to seek help for her thin baby, sickened by hunger. As she trudged slowly across the bleak landscape, choked by famine and drought, she wondered whether her infant son, Sadik, would survive.

“If Allah wants him to die, he will die,” said Muhumed, her voice dropping. “I have seen many people who have died along the way.”

“These are becoming roads of death,” Josette Sheeran, executive director of the U.N. World Food Program, told reporters in Nairobi over the weekend. “Over half the women I talked to had to leave children to die or had children die.”

“In the Horn [of Africa], we could lose a generation,” she added. “Those that survive could be affected deeply.”

On Sunday, Muhumed held her frail son in this border town, where they had arrived a day earlier after a month-long journey. Sadik was listless, his eyes half closed, his skin leathery from malnutrition. Moments earlier, he had vomited the little milk he had swallowed.

There were no doctors, no aid agencies distributing food. Many of the new arrivals sat under trees or on vacant patches of land, waiting for help.

“I am asking the international community to give me medication to help my child and food to feed my family,” Muhumed pleaded. “So far, I have not gotten any support.”

The last time famine struck Somalia with such intensity was in 1992, killing hundreds of thousands and triggering a U.S.-led peacekeeping mission that ended with 18 American troops killed in a 1993 battle in the capital, Mogadishu. Last week, the United Nations formally declared famine in two southern Somali regions, and aid officials predict that the entire south could join the list within a month or two. About 3.2 million people in Somalia need lifesaving assistance, the United Nations said. As many as 19 to 24 children per 10,000 under age 5 are dying every day in some areas, according to the World Food Program.

‘We have nothing now’

For months, Hawa Madey relied on her relatives for help. Her family’s crops had mostly failed, and her herd of cattle and goats had died. The conflict had isolated her area, slashing trade with other regions. The price of sorghum, the staple food, had soared more than 70 percent there.

In 2009, al-Shabab banned aid agencies from areas it controlled, accusing them of being Western spies or Christian crusaders. This year, growing U.S. strikes against the militia have heightened suspicions and complicated negotiations to provide aid, U.N. officials said. Last week, al-Shabab reversed a pledge to allow foreign aid agencies to enter its areas to help victims.

The militants also undermined whatever meager food Madey could sell in the market. They demanded an Islamic tax, called zakat, for everything she sold. Such a tax is typically 5 to 10 percent, but she said the fighters exacted much more. Then, her relatives lost their crops and livestock — and it was time to leave.

“We have nothing now,” said Madey, 25, who arrived in Dolo on Saturday night with her two children after walking 60 miles over four days.

She looked at her children, ages 2 and 3 months. They had yellowing skin and small sores on their heads, signs of severe malnutrition. Madey said softly: “I worry a lot about what will happen to my babies. Can you help?”

Nearby, seated under a leafless tree, 1-year-old Amiso was in worse shape. She suffered from diarrhea and anemia. Her eyelids were white. “Since she was born, we have fed her only diluted milk,” said her mother, Gani Ibrahim.

They had walked for two days from an area controlled by Somalia’s weak and corrupt U.S.-backed transitional government, which has devoted few resources to alleviate the crisis. The government is focused on preventing al-Shabab from creating an Islamic emirate in Somalia — the latest incarnation of civil war since the country was plunged into chaos by the overthrow of dictator Mohamed Siad Barre in 1991.

Aid falling far short

Help from the international community has been slow to arrive. Aid agencies have been sounding the alarm for months, but funding from the United States and other Western donors is several hundred million dollars short of what is needed. At the Dollo Ado refu­gee camp in Ethiopia, where many of the displaced in Dolo were heading, an additional 13,000 tents are needed to meet the fresh influx, said the United Nations’ refugee agency.

Meanwhile, aid agencies are struggling to keep the flood of refugees from overwhelming neighboring countries. The World Food Program is planning to open new feeding sites in Dolo by the end of the week, but that could be too late for infants such as Sadik, whose bodies have swiftly deteriorated after their long journeys.

Muhumed knows she cannot return home. Her cattle and goats are dead. Her husband was on the way to Dolo, along with their four other children. She wiped away Sadik’s vomit from her red blouse and resumed waiting in a line to sign up for food aid. If they don’t get food and medication here, she said, they will cross into Ethiopia.

With each passing day, she worries that her boy will die. “If we don’t get support, it will happen,” she said matter-of-factly, as if she had prepared herself for the worst.