One in three people in northern Ethiopia are facing extreme hunger, the UK-based charity Oxfam says.
That’s a total of almost 10 million people in the regions of Tigray and Amhara.
Conflict and drought have significantly reduced harvest forcing millions to resort to what the charity calls “unimaginable ways” to survive.
A report by a federal government agency said nearly 400 people had already died in the two regions due to starvation.
But this was contradicted by Ethiopia’s Prime Minister Abiy Ahmed, who said no deaths had occurred in the country solely because of hunger.
Unless relief efforts are scaled up, Oxfam is warning that northern Ethiopia could see a worsening humanitarian catastrophe.
A gap in funding and ongoing conflicts in Amhara have made humanitarian responses difficult.
When alleged looting of food aid was uncovered by the World Food Programme and USAid last spring, they halted aid to Ethiopia for months on end until resuming at a lower rate in December.
Last year, the UN managed to get only a third of its $4bn (£3.2bn) appeal for Ethiopia.
Officials in Tigray say famine is looming, but the federal government has dismissed the possibility of famine.