(Bloomberg) -- As many as 43,000 people are estimated to have died in Somalia last year as a result of the east African nation’s worst drought in more than four decades, according to the government and United Nations agencies. 

“Half of these deaths might have occurred among children under the age of five,” Somalia’s Ministry of Health and Human Services said in a joint statement with the World Health Organization and the UN Children’s Fund on Monday. “These estimates suggest that although famine has been averted, for now the crisis is far from over.”

Rains in Somalia, one of the world’s most climate-vulnerable countries, have failed for six consecutive seasons and water shortages are even worse than in the early 1990s when a famine claimed about 260,000 lives. Almost half of its 17 million people remain in urgent need of aid. The government and the UN estimate between 18,100 and 34,200 more people could die in the first half of this year because they don’t have enough to eat or drink.

Read more: Horror of a Hotter World on Stark Display in Parched East Africa

The estimates are the first official attempt to quantify the death toll as a result of the drought, the effects of which have been compounded by high inflation and shortages of wheat and other staples stemming from Russia’s invasion of Ukraine. Ascertaining an accurate figure is tricky because Islamist militant group al-Shabaab has been trying to topple the government since 2006 and some parts of the country remain unstable and inaccessible to the authorities. 

While a military offensive has freed a large swathe of territory from the al-Qaeda-linked group’s control over recent months, it still has strongholds in central and southern Somalia and maintains a presence just 30 kilometers (10 miles) outside Mogadishu.

“We continue to be concerned about the level and scale of the public health impact of this deepening and protracted food crisis in Somalia,” Health Minister Ali Hadji Adam Abubakar said in a statement.

Read more: Why East Africa Is Facing Its Worst Famine in Decades: QuickTake

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