Killings, kidnappings and the threat of famine are turning the Horn of Africa into the most dangerous and deadly spot on earth.

Already plagued by drought, food shortages and massive malnutrition, Ethiopia and Somalia are now facing a potentially catastrophic humanitarian crisis, say international aid workers.

“Some people are equating it to 1991 and 1992,” when hundreds of thousands died of starvation, said Marilyn McHarg, director of Medecins Sans Frontieres Canada.

“As far as the violence is concerned, we see that it is really deteriorating. The bottom line is anarchy, which impacts on the population.”

So far, 19 foreign aid workers have been killed in Somalia this year. In January, three MSF staffers died in a roadside car bombing in the southern town of Kismayo, while a fourth was killed in an ambush near Mogadishu in March.

This week, a World Food Program contractor was gunned down in Mogadishu, the fifth WFP employee to die in the country this year.

Lately the killings have become more dramatic and targeted. On July 6, gunmen assassinated Osman Ali Ahmed, head of the UN Development Program in Mogadishu, as he left a mosque.

Last Friday, men armed with pistols killed the deputy head of a German charity, Bread for the World, in Mogadishu, while the head of a Somali aid organization was gunned down the same day as he distributed food to refugees just south of the seaside capital. The surge in violence has been accompanied by a dramatic increase in abductions and kidnappings that has seen 13 foreign aid staffers, including two Italians, a Kenyan and a Briton, being held for ransom.

Threatening leaflets have appeared warning local employees of international aid organizations to quit their jobs.

“The attacks on aid workers, the number of people being killed, the number of abductions, ambushes and car lootings are all going up,” said Ms. McHarg. “What is happening is our humanitarian space is just shrinking to a point that we are finding it really difficult to maintain our presence.”

Suspicion for the killings and kidnappings usually falls on Islamist rebels, some linked to al-Qaeda, who have vowed to wage an Iraq-style insurgency against Somalia’s internationally backed transitional government and its Ethiopian allies.

MSF is maintaining a dozen projects in central and southern Somalia, but limits the amount of time expatriate aid workers spend in the country for security reasons.

After the assassination of the UNDP director, the UN withdrew all staff from Baidoa, the seat of Somalia’s transitional government. UN workers are limited to same-day visits to Somalia and are forbidden to stay overnight.

“It is intolerable and incomprehensible that humanitarian workers striving to save lives and alleviate human suffering in one of the most difficult environments in the world are being targeted and killed,” said Mark Bowden, the UN’s humanitarian co-ordinator for Somalia.

While Somalia’s torment has its roots in decades of lawlessness — it has not had a fully functioning government since 1991 — neighbouring Ethiopia is now caught in the vise grip of a prolonged drought.

In the past two months, MSF has treated 9,500 severely malnourished children in the region.

“It’s just the tip of the iceberg,” Ms. McHarg said. “As many as 10% of our admissions are people over 14 years of age. Normally in malnutrition outbreaks, you will see children under five, because they are the most vulnerable. When you start seeing children who are older, you know you are having a situation that is more compromised.”

pgoodspeed@nationalpost.com