So who is to blame?
Here, in the aid and development hub of Kenya's capital, Nairobi, most of those involved in the relief efforts across the Horn of Africa are too busy to get distracted by finger-pointing.
But there is plenty of muttering on the sidelines.
And so here is my top 10 compilation of alleged culprits for your consideration - drawn from conversations with experts, diplomats, Somali officials, foreign aid workers and some of the hungry themselves.
I will leave the blindingly obvious - the drought itself - out of it. But please weigh in with your own lists or arguments.
1. The US - only interested in Somalia in relation to the "war on terror", piracy and oil - according to many.
Washington is extremely squeamish about allowing even a cent of aid money to get into the hands of al-Shabab, the militant Islamist group which controls large parts of Somalia and is linked to al-Qaeda.
It results in a kind of ambivalent attitude to aid in Somalia that has hamstrung plenty of crucial humanitarian programmes.
Drought but also human failures are responsible for this malnourished child's plight
"The Americans want to be half pregnant," was how one top European official put it to me, in disgust.
2. The UN's World Food Programme (WFP) - the one organisation with the real muscle to end the famine, but because it is heavily dependent on US funding, and tied up in beltway politics, WFP has struggled to secure the necessary guarantees to access al-Shabab territories.
To be fair, it is a lot more complicated than that - as I've seen first hand. WFP has had many workers killed in Somalia - giving it every reason to be cautious.
And its size makes it hard to work under the radar, like some other UN agencies do. But WFP's leadership, some here grumble, tends towards a style of megaphone diplomacy that does not always win friends on the ground.
3. Somalia's Transitional Federal Government (TFG) - this Western-backed administration is so weak, marginalised and lacking in territory that the most important role it can play right now is to keep out of the way of those fighting the famine.
But the TFG is also a broader symbol of the outside world's obsession with a top-down approach to state building in Somalia. Many believe that has prolonged the conflict - and fuelled the famine.
"Talk to local communities - don't buy yourself a government just so you've got a prime minister to talk to," is how one weathered Somali-watcher put it.
4. Al-Shabab - they have killed aid workers and blocked outside help from getting in. What more is there to say?
Well, remember that al-Shabab is an umbrella, not a cohesive organisation.
As some humanitarian organisations have understood for longer than others, it pays to ignore the vitriolic spokesmen and concentrate on winning round individual commanders and communities.
Some here ponder whether there may be an opportunity lurking behind the famine - as communities outraged by al-Shabab's behaviour finally find the strength to confront them. There are signs that's happening - but on a limited scale.
5. The F-word - famine, and our obsession with it. By which I mean the collective habit of only finding the necessary money and sense of urgency when it is too late.
These days Somalia's population is, fortunately, one of the most heavily monitored in the world. It is not just crude malnutrition rates that are factored in, but other far more sophisticated indices like household debt.
As a result, the good news is that the world has responded faster than it might have done. And yet - as I saw yesterday on a brief stopover in the arid north of Kenya - if the world put as much effort into long-term programmes to build resilience in communities, as it is now doing to feed the hungry, this famine would never have happened.
6. The media: which brings us neatly on to journalists. We are, as one leading humanitarian official told me - with a mixture of flattery and frustration - absolutely crucial in all this.
The UN can produce endless, detailed documents, but the politicians who make the big decisions only react when they see it on the television or the front page. It has been a busy year for news elsewhere, but should we be blamed for waiting too long?
7. Kenya - as I mentioned above, I have just spent a day rushing round development projects in northern Kenya. Two simple facts emerged - Kenya's government has woefully, scandalously underinvested in livestock support, education, and basic infrastructure in its most vulnerable communities.
And when communities are properly helped, they can prepare for, and cope with, the toughest droughts. Maybe this is not directly linked to the chaos in Somalia - but it shows what can be done, and highlights what is not.
8. Everyone else: "Let us not stand back," was how South African Archbishop Desmond Tutu put it. And yet most of Africa is doing just that (how often has the famine made the front pages in newspapers on this continent?), and so is the Middle East, China, and plenty of other countries.
Is this a response to the flaws and failures of the Sisyphean humanitarian efforts in Somalia over the past two decades? Or plain tight-fistedness?
9. Climate change - if you accept the science, then you have to accept that these droughts are going to be coming thick and fast in the coming decades. And we all share a responsibility for that.
Then again, I understand that Lower Shabelle - now labelled a famine zone - had a bumper harvest last year. Mitigation is possible. A call to action then, not a reason to give up on the Horn of Africa.
10. Population growth - this is crucial. In areas of northern Kenya the population has reportedly doubled in the past decade.
"Twice as many people, but the same number of livestock. This is unsustainable," a UN agriculture expert told me.
Pastoralists are famously adaptable - they have to be to survive. But the pressures now facing them are overwhelming, and accelerated urbanisation looks inevitable.
The key is to make sure that process happens in sustainable places, and not, for example, in the arid plains where Kenya's unofficial new city, Dadaab - the world's largest refugee camp - is bursting at the seams and lowering the water table.
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