Somalia’s ongoing record drought may have killed as many as 43,000 people last year, and half of them were children under the age of five, according to a report released by the government and United Nations agencies.

The research released on Monday marked the first attempt to estimate countrywide deaths in a crisis that experts warn is more severe than the country’s last major drought in 2017 and 2018.

Led by the London School of Hygiene and Tropical Medicine, the study warned that the rate of fatalities could rise in the first half of 2023 as it projected total deaths for this period from 18,100 to 34,200.

“These results present a grim picture of the devastation brought on children and their families by the drought,” UNICEF’s Wafaa Saeed said as he presented the report in Somalia’s capital, Mogadishu.

Mamunur Rahman Malik, a representative of the World Health Organization in Somalia, said the international community faces a race against time to prevent deaths that are avoidable and save lives.

“We have seen deaths and diseases thrive when hunger and food crises prolong,” he said in a statement. “We will see more people dying from the disease than from hunger and malnutrition combined if we do not act now. The cost of our inaction will mean that children, women and other vulnerable people will pay with their lives while we hopelessly, helplessly witness the tragedy unfold.”

The UN says five consecutive failed rainy seasons in Somalia have left five million people with acute food shortages and nearly two million children at risk of malnutrition.

In December, the Integrated Food Security Phase Classification, which sets the global standard for determining the severity of a food crisis, said the famine that some experts were expecting had been temporarily averted, but it warned the situation was getting worse.

Francesco Checci, a co-author of the study, said the lack of a famine designation should not distract from the scale of the crisis.

“What we are actually showing is that it isn’t time to slow down in terms of funding and humanitarian response,” he said.