ARI SHAPIRO, HOST:

We often bring you news of hunger around the world, but it's rare for food insecurity to reach famine levels. It means things have become extraordinarily bad, and that hasn't happened in seven years until now in Sudan because of the ongoing civil war there. This month a group of U.N.-backed experts concluded that more than half a million people are living in famine conditions with million more at risk, and yet famine still has not officially been declared in Sudan. This is an important distinction, even if it sounds technical, and to explain, NPR global health correspondent Fatma Tanis is here in the studio. Hey, Fatma.

FATMA TANIS, BYLINE: Hi, Ari.

SHAPIRO: What does it mean to say that famine conditions exist? How do experts reach that conclusion?

TANIS: So let me start by taking you back. After the famines in the 1980s, the international community, they came up with a system to designate the seriousness of food emergencies around the world, with famine being the most extreme level possible. So a group of independent experts called the Famine Review Committee, they analyze data and can only conclude that there is famine when certain thresholds have been met. So if 20% of households are facing an extreme lack of food, if malnutrition rates among young children are high and if people are dying.

Now, in this case, in Sudan, they had data from a camp for displaced people called Zamzam camp in North Darfur, which is in the west, where over half a million people are sheltering. I spoke with Lark Walters. She's with the Famine Early Warning Systems Network, which is part of the Famine Review Committee. Here's what she said.

LARK WALTERS: And in Zamzam camp, we had data that confirmed the acute malnutrition threshold for famine had been passed and that the mortality threshold was nearly passed as early as January.

TANIS: You heard her say January, Ari, which means that the famine threshold technically passed eight months ago, but it takes time for them to analyze and reach a consensus. And in that time, of course, we know that conditions in Sudan have deteriorated.

SHAPIRO: This sounds technical, but we're talking about people's lives and ability to feed themselves. How are they actually surviving in those areas?

TANIS: It's really grim. You know, conditions were already catastrophically bad. Since January, the conflict has escalated. North Darfur is under siege. Aid groups are now saying it's at a breaking point. They're saying that people are boiling dirt in water just to be able to calm children who are crying out of hunger. There are reports that people have been selling children to marriage or to become child soldiers out of desperation so they can survive.

And we should note that this is all happening as humanitarian aid is being blocked by both the paramilitary group, the RSF, and the Sudanese Army, which have been in a civil war for over 15 months. Top of that, it's the dry season. People can't grow their own food. So, as hard as it is to imagine, things are going to get even worse.

SHAPIRO: We are in another part of the program talking with the U.S. envoy for Sudan, who is trying to negotiate peace talks. If the situation is already at a breaking point and likely to get worse, what happens next?

TANIS: So the scientists and the data analysts, they've done their part. What needs to come next is political action, and that's where the bureaucracy kicks in. Now, since famine has been classified, the Sudanese government and the United Nations have to come together and officially declare famine. But in this case, the Sudanese government has repeatedly denied the existence of famine. They say they don't believe the data. And humanitarian experts say the U.N. should step in and do it, but the U.N. says it's up to the internationally recognized Sudanese government. Now, I spoke with the head of the U.N. office for humanitarian affairs in Sudan, Justin Brady, and here's how he put it.

JUSTIN BRADY: We've requested a meeting with the government. We're waiting for confirmation on that to discuss with them and to see, you know, what it will take for them to recognize the conditions that the food security experts have concluded.

TANIS: And there's frustration among the humanitarian community over the way this bureaucracy is playing out, Ari. They feel that the U.N. is being deferential to the Sudanese government, even as children are dying of hunger every day.

SHAPIRO: If we know people are dying of hunger and that it is as bad as it gets, then why is it important for famine to be officially declared?

TANIS: So aid officials say that it mobilizes international humanitarian response like convoys of trucks of food, of medicine being able to get into Sudan. That's what they say happened in Somalia back in 2011, when the U.N. declared famine in the absence of a functioning government there. Now, food security experts say they need convoys of trucks with food and nutritional supplements to go in, not only to treat the people who are malnourished, but to save the rest of the population as well. The World Health Organization says 8.5 million people are in emergency levels of food insecurity. That's a step away from famine. But as of today, it's difficult to get even a single truck of aid, supplies into famine areas. The U.N.'s Justin Brady told me that time is running out. He's seen estimates that show up to 4 million people will die if Sudan isn't flooded with help immediately.

SHAPIRO: NPR's Fatma Tanis. Thank you.

TANIS: Thanks, Ari. Transcript provided by NPR, Copyright NPR.

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