The result is that today, nearly half of children under five are malnourished or at risk of malnutrition. In January, MSF opened a therapeutic feeding project in El Wak and five surrounding districts to care for children who had become severely malnourished- meaning that they were in need of intensive medical care in order to survive. So far 170 children have been treated.

The familiar sound of an Imam's voice drifts through the searing heat of the early morning in El Wak, a town in the far north-east of Kenya. But his call is not for the souls of the faithful. Instead, he is praying for rain.

A combination of the full or partial failure of the past three rainy seasons, neglect from home as well as abroad, and the decades-long overstretching of natural resources has been devastating. The earth in El Wak is a bleached moonscape scattered with thorn bushes and the carcasses of dead animals.

At regular intervals along the rutted tack that makes up much of the 850km between the Kenyan capital, Nairobi, and El Wak, women and children wait forlornly with buckets and jerry-cans in the hope that one of the rare passers-by will give them water.

In many places there is simply no water left, the pastures have dried up and thousands of animals have died, depriving much of the primarily pastoralist population of their livelihoods.

"No livestock means no food," explains Medecins Sans Frontieres (MSF) emergency co-ordinator Ibrahim Younis. "People live on the meat and milk that their animals provide and now, many have nothing."

The result is that today, nearly half of children under five are malnourished or at risk of malnutrition. In January, MSF opened a therapeutic feeding project in El Wak and five surrounding districts to care for children who had become severely malnourished- meaning that they were in need of intensive medical care in order to survive. 170 children have been treated so far.

"We had people at the office from dawn to dusk begging for water," explains Ibrahim Younis, of MSF. "Our initial aim was to provide therapeutic feeding, but when we realised how critical the water situation was, we had to quickly begin providing it to villages. Up to now we've delivered about half a million litres, but the appalling state of the roads has made this a tough task." The story of 20 year-old Khero Abdi is typical.

"The animals are all dead or dying and the people are weak," she explains, cradling her child who had been admitted into the centre three days before. "I had almost 80 cattle, they are all dead. I only have five camels and a few goats left. We've got no food and no water and we can't sell the animals to get any."

But this time at least she won't lose her son. Severely dehydrated and malnourished on arrival, 18 month old Abdullahi is recovering well and today alone has put on 200 grams in weight. "He will be out soon," smiles MSF clinical officer Ibrahim Ahmed.

Strong coping mechanisms among the local population, which faces chronic food shortages in most years, bolstered by food distributions, have played an important role in keeping the number of children in the MSF therapeutic care project relatively low. But with 19% of children already moderately malnourished and a further 20% on the brink, the situation could deteriorate quickly.

When the project began at the start of the year, the greatest concern was over water.

"We had people at the office from dawn to dusk begging for water," explains Ibrahim Younis. "Our initial aim was to provide therapeutic feeding, but when we realised how critical the water situation was, we had to quickly begin providing it to villages. Up to now we've delivered about half a million litres, but the appalling state of the roads has made this a tough task."

The lack of water and food has other serious consequences on health. Hygiene suffers and malnutrition weakens children in particular, leaving them more vulnerable to disease. A measles outbreak has forced the MSF team to carry out an emergency vaccination, which began on 8 March. On the first three days alone, over 9, 000 children were vaccinated. Within 14 days, the aim is to vaccinate around 27, 000.

A further huge challenge for MSF is the mobility of the population in a region which covers 26, 474 square kilometres. Around 70% of the people are pastoralists coming from what locals call the 'badia,' an Arabic term which loosely translates as 'the bush' or 'nomads.' In search of pasture for their animals, they move hundreds of kilometres every week, even across the border into Somalia.

A traditional therapeutic feeding programme based in a health centre or hospital is largely ineffective. The project has to be adapted and MSF now carries out ambulatory feeding, screening and treating children at a number of different points throughout the five districts covered.

Severely affected by the drought, the worst off are found amongst those from the badia. With their livestock gone and their means of survival with it, many desperate pastoralists have pitched in ragged camps around established settlements. They have become known as the 'drop-outs.'

One such camp, El Haji, is located 3 km south of El Wak. Named after the nearby borehole, the camp is a picture of desolation. Shelters have been erected with scrap materials ranging from bits of wood to old tattered items of clothing. They provide virtually no protection from the sun, nor from the constant wind which whips up a fine dust from the scorched earth.

It is one of dozens of similar camps around the area and while the total number of drop-outs is unclear, over a thousand people have settled in El Haji alone and more arrive destitute every day. An MSF driver, Ali, sums up the situation. "I have lived here all my life and I have never seen anything like this," he says as he surveys the scene.

Few have. According to the people of El Wak, this drought is the harshest for 15 years and unless the prayers of the Imam are answered soon, it could become significantly worse yet.