The rains are a mixed blessing in Karamoja. They came initially as a relief in April, having not seen rain since last November. The dust settled, and the fields and hills turned green before our eyes. It was a welcome sight in a dry landscape that had become burnt and inhospitable. People began to dig and plant their crops.

It’s tempting to see the arrival of the rains as the beginning of something good, a positive moment in the annual cycle. But in Karamoja the rains also herald the start of something more worrying—the hunger season.

And what has become clear over the last few weeks is that for some families in Karamoja, these are extremely hard times.

Karamoja, tucked in the north east corner of Uganda, is a vast, flat plain, dry and dusty for most of the year. It is home to nomadic tribes, for whom cattle are both a source of food and wealth, and the center of the cultural and economic life. Conflict has been a feature of life here, as heavily armed warriors raid cattle from each other, a practice that is both a tradition with social and spiritual significance, and a means of survival.

Changing patterns of weather and migration mean that most communities no longer rely purely on their cattle, but on small-scale farming for their food. In an environment where the rains are sporadic and the soils are poor, it is a precarious existence. Markets are opening up, but prices are high and people do not have access to cash, or the means to make money—in hard times many rely on selling what few possessions they have.

And what has become clear over the last few weeks is that for some families in Karamoja, these are extremely hard times.

Even in good times, a harvest will not sustain most families until the next year.

Recent nutrition surveillance has shown that levels of malnutrition in Karamoja, especially for children under two years, are now above recognized emergency levels. In technical terms, this means that more than two percent of children under five years old are suffering from severe malnutrition. In some parts of Karamoja, the numbers are twice as high as ‘emergency’ levels. In practical terms, what this means is that more than 3,300 children are at-risk in Karamoja.

Concern and our partners have been working with the local health services for the last number of years to help them deal with on-going problems of child malnutrition, but also to prepare to respond when things get bad. Together we are now scaling up our response, putting this preparation into action.

The first step is a mass screening—literally going door to door in every village to make sure that we can identify those most at-risk. It’s a complex environment and much of the hunger is ‘hidden’. We estimate that less than one-third of cases are properly identified and brought for treatment.

Secondly, we ensure that the local health centers have the all the equipment and supplies they need deal with increasing numbers of children with severe malnutrition and sickness. We are also ensuring that those children who may not need immediate care, but show signs that they are at risk of malnutrition, can access programs where they can get rations of food to prevent them becoming dangerously sick.

In a region where the populations are so spread out, where in some places there are only three small clinics for 100,000 people, we are also supporting a mobile clinic to reach the most remote areas.

The causes of this crisis are complex. Even in good times, a harvest will not sustain most families until the next year.

And while the rains are here, it’s unclear how successful the next harvest will be. At times the rain has been too strong and the ground too dry; which means in some places we’ve seen fields flooded and crops washed away.

For now, what matters most is how we react to this situation, identifying those most at risk and reaching them in time.

The rain also brings the threat of disease. Around 70 percent of children in the recent surveillance were reported to have had an illness in the previous two weeks. Given the conditions, a simple case of diarrhea can be fatal.  Malnutrition and sickness go hand and hand in a vicious cycle; a hungry child is more likely to get sick and a sick child is more likely to go hungry. That’s why the arrival of the rain brings both joy and misery.

We hope that the preparation we’ve done over the last three years and the increasing support will limit the impact of this crisis on the most vulnerable in Karamoja.  Concern is committed to long-term solutions aimed at preventing malnutrition – working with parents on how best to care for their children, helping them to grow nutritious food and supporting people to create a more sustainable livelihood.

For now, what matters most is how we react to this situation, identifying those most at risk and reaching them in time. With the next harvest not due until September, the next few months are crucial for the most vulnerable children in Karamoja.