BAIDOA, Somalia — First the trees dried up and cracked apart.
Then the goats keeled over.
Then the water in the village well began to disappear, turning cloudy, then red, then slime-green, but the villagers kept drinking it. That was all they had.
Now on a hot, flat, stony plateau outside Baidoa, thousands of people pack into destitute camps, many clutching their stomachs, some defecating in the open, others already dead from a cholera epidemic.
“Even if you can get food, there is no water,” said one mother, Sangabo Moalin, who held her head with a left hand as thin as a leaf and spoke of her body “burning.”
Another famine is about to tighten its grip on Somalia. And it’s not the only crisis that aid agencies are scrambling to address. For the first time since anyone can remember, there is a very real possibility of four famines — in Somalia, South Sudan, Nigeria and Yemen — breaking out at once, endangering more than 20 million lives.
International aid officials say they are facing one of the biggest humanitarian disasters since World War II. And they are determined not to repeat the mistakes of the past.
One powerful lesson from the last famine in Somalia, just six years ago, was that famines were not simply about food. They are about something even more elemental: water.
In some areas of central Somalia, a 20-liter jerry can of water, about five and a quarter gallons, used to cost 4 cents. In recent weeks, that price has shot up to 42 cents. That may not sound like a lot. But when you make less than a dollar a day and your flock of animals — your family’s pride and wealth — has been reduced to a stack of bleached bones and your farm to dust, you may not have 42 cents.
“There is no such thing as free water,” said Isaac Nur Abdi, a nomad, who sat in the dusky gloom of a cholera treatment center in Baidoa this month. He fanned his elderly mother, whose cavernous eye sockets and protruding cheekbones bore the telltale signature of famine.
Scenes like this are unfolding across the region. In Yemen, relentless aerial bombings by Saudi Arabia and a trade blockade have mutilated the economy, sending food prices spiraling and pushing hundreds of thousands of children to the brink of starvation.
In northeastern Nigeria, thousands of displaced people have become sick from diseases spread by dirty water and poor hygiene as the battle grinds on between Islamist militants and the Nigerian military, which, when it comes to protecting the vulnerable, does not have the most stellar record. The Nigerian Air Force bombed a displaced persons camp in January, killing scores, saying it was an accident.
In South Sudan, both rebel forces and government soldiers are intentionally blocking emergency food and hijacking food trucks, aid officials say. On Saturday, six aid workers were killed, complicating relief efforts even further. Entire communities are marooned in malarial swamps trying to survive off barely chewable lotus plants and worm-infested swamp water.
While the other countries are technically on the brink of famine, the United Nations has already declared parts of South Sudan a famine zone.
Scientists have been saying for years that climate change will increase the frequency of droughts. The hardest-hit countries, though, produce almost none of the carbon emissions that are widely believed to cause climate change.
South Sudan and Somalia, for instance, have relatively few vehicles and almost no industry. But their fields are drying up and their pastureland is vanishing, scientists say, partly because of the global effects of pollution. People in these countries suffer from other people’s driving, other people’s manufacturing and other people’s attachment to things like flat-screen TVs and iPads that most Somalis and South Sudanese will touch only in their dreams.
It’s not simple to get food and clean water into these areas where everything is dried out, yellow and dead.
Baidoa itself is controlled by Somalia’s fledging government and African Union troops. But just a few miles outside the town, it is Shabab country, belonging to the Shabab militant Islamist group that has banned Western aid agencies.
”The fact that people are dying near Baidoa and we can’t get there, it makes me crazy,” said Patrick Laurent, a water and sanitation coordinator hired by Unicef in Somalia.
After Somalia’s last famine, the multibillion-dollar aid industry thought it had come up with an answer to prevent the next one: resilience. It was the new buzzword in aid circles, bandied about at workshops and among high-powered officials.
Aid officials defined resilience as the ability to adapt to sudden environmental or political shocks. Resilience programs included livestock insurance and better water management, especially in Africa.
Some aid officials never liked this term, saying it seemed patronizing, as if Africans were built to suffer. Still, the resilience subindustry roared on.
But just as many of the new resilience programs were being funded, these latest crises hit, one after the other.
“The environment didn’t give time for these resilience efforts to bear fruit,” Mr. Laurent said.
Ms. Thomas, the Unicef water and hygiene specialist, said that during Somalia’s last famine, the deadliest areas were not the empty deserts where there was little food but the displaced-persons camps near urban areas where, comparatively speaking, there was plenty of food.
The reason was that the crowded camps became hotbeds of communicable diseases like cholera, a bacterial infection that can lead to very painful intestinal cramps, diarrhea and fatal dehydration. Cholera is often caused by dirty water and spread by exposure to contaminated feces through fingers, food and flies.
Malnutrition certainly played its part; famine victims, especially children, were compromised by a lack of nutrients. They arrived in the camps from wasted areas of the interior with their immune systems already shot.
But in the end it was poor hygiene and dirty water, Ms. Thomas said, that tugged many down.
If rivers and other relatively clean water sources start drying up, as they are right now in Somalia, this sets off an interlocking cycle of death. People start to get sick at their stomachs from the slimy or cloudy water they are forced to drink. They start fleeing their villages, hoping to get help in the towns.
Camps form. But the camps do not have enough water either, and it is hard to find a latrine or enough water for people to wash their hands. Shockingly fast, the camps become disease factories.
Water, of course, is less negotiable than food. A human being can survive weeks with nothing to eat. Five days without water means death.
Different strategies are being emphasized this time around to parry the famine. One is simply giving out cash.
United Nations agencies and private aid groups in Somalia are scaling up efforts to dole out money through a new electronic card system and by mobile phone.
This allows poor people to get a monthly allowance and shop for staples like fresh vegetables, powdered milk, pasta, dates, sugar, salt and camel meat.
Cash payments are often better for the local economy than importing sacks of food, and the people get help fast.
Many more Africans may soon need it. Sweltering days and poor rains so far this year have left Burundi, Kenya, Rwanda, Uganda, Ethiopia and Tanzania parched and on the edge of a major food crisis.
At the cholera treatment center in Baidoa, which logged in more than 30 cases on a recent day, many people had little inkling of what caused cholera.
When Mr. Abdi, whose mother was nearly dead from the disease, was asked what had made his mother sick, he said the cause was simple.