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On a dusty plain in northeastern Uganda, two women have come to blows. One shrieks as the other shoves. A volunteer from the World Food Program (WFP) has called one of them forward to collect an emergency food-aid ration, but both women want it. "They have the same name," explains local administrator Teko John Bosco.

He laughs uncomfortably and scans the teeming plain. More than 2,000 residents of this parish, Lokali, have come to collect food aid on a hot Saturday in May, and though the crowds have dwindled as the sun sinks and people drag or carry home their sacks — a month's ration of mostly corn, with some beans — many recipients remain. They stand or sit in groups, waiting for food if they haven't yet been called, and arguing over how to divide the rations they've received. At the center with the food stash, police clutch assault rifles to scare off bandits, as well as sticks to beat recipients who try to steal. With just a few dozen sacks remaining, would-be thieves sprint in as a pack, and more join in as the numbers swell. "It always happens this time of day," Teko says. The officers thrash them all — old women and children too — until they drop the sacks and scatter.

Extreme hunger, and the scenes of desperation it causes, is shockingly common. WFP, the U.N. food-aid agency, reaches more people than any other humanitarian organization in the world. It plans this year to feed about 90 million in 78 countries; almost all of the recipients hover on the brink of starvation. Here in Karamoja, in Uganda's semi-arid northeast corner, food distribution is now a daily ritual. In its 45-year history, WFP has handled war, famine and just about every other kind of disaster, natural or made by man. But Karamoja is pretty typical. After years of drought, the soil is little more than sand. Goats and cattle are gaunt from lack of grazing and the sorghum crop is failing. Armed cattle rustlers roam the region, making the roads too dangerous for most travel. Commercial transporters refuse to haul in WFP goods, despite escorts from Uganda's national army. Yet the biggest challenge the Rome-based agency has ever faced, executive director Josette Sheeran announced in April, came this year: the exploding price of food.

WFP had planned in 2007 that $2.9 billion — donations that mainly come from rich-world governments — should cover operations for 2008. By late March, rising food prices meant those same operations were going to cost an extra $500 million; by the end of April, the estimated shortfall was $755 million. Donations have trickled in and, to fill the gap, Saudi Arabia pitched in a windfall $500 million in late May. But if prices stay high — and agriculture experts believe they will — WFP will need to raise those extra hundreds of millions, year after year, just to maintain services at their 2007 level. Yet the organization faces new demands from people whom, a year ago, it did not expect to have to help.

"What we're seeing is that people living under $2 a day are giving up health care and education," says Sheeran. "Those living on under $1 a day are giving up protein once a week or vegetables." And those on 50¢ a day or less, like the people of Karamoja, are simply cutting out meals. Men and women say they were eating at most once a day before WFP came with its meager rations. "We've just been surviving selling firewood and burning [wood to make] charcoal," says Cecelia Amaitukei, a Lokali food-aid recipient.

In the past, such economic activity might have been enough to keep a family eating when its own crops died. This year, the labor isn't worth enough to buy real food. The women take their firewood and charcoal to local brewers and trade it for the grainy residue of beer instead. Then they eat that. Death rates in the local hospital's child-malnutrition program are twice the level they were in 2006-07. "We would have had more deaths," says James Lemukol, the hospital superintendent, "if there were no [regional] intervention from WFP."

Karamoja is not like most of Uganda. In fact, precisely because it is so varied, the small east African country is a good example of how WFP's worldwide operations have been hit by high food prices. WFP buys more food in Uganda than in any other country in the world. Most of the land is lush and fertile, and the government is stable; President Yoweri Museveni has ruled since 1986. Last year WFP's administrative center in the capital city Kampala, then responsible for 11 countries in eastern and central Africa, handled some 15 million recipients and about one-third of WFP's annual global food distribution.

Sitting at his desk in Kampala, Uganda Country Office Director Tesema Negash rattles through the groups that make up the roughly 2 million WFP-aid recipients in the country. There are more than 170,000 refugees from neighboring countries, and nearly 1 million who have been "internally displaced" in northern Uganda by a long-running guerrilla war. Then there are the residents of drought-stricken Karamoja, as well as pregnant and nursing mothers and HIV/AIDS patients. A ballooning food budget, coupled with the off-again, on-again nature of donor funding, have threatened nearly every Uganda program at some point this year. "Prioritization is extremely difficult for us," Negash says, "because all these categories, all of them, they're almost totally dependent on us."

The Uncertainty Principle
In some ways WFP is more like a global shipping company than an aid agency. Every Monday through Friday — weekends too if there's an emergency — empty trucks pull up at the warehouse in Kampala, bound for destinations around Uganda and neighboring countries. Nearly 200 porters jog around the warehouse, a steady stream of men carrying 100-lb (50 kg) bags of food on their heads. Trains and trucks arrive full from local traders and from the port city of Mombasa, Kenya, where ships bring donated food from the U.S. and other Western countries. (About two-thirds of WFP's food here is purchased locally, and one-third is donated in kind.) A local bean supplier arrives. Two women in blue lab coats take samples, check that there isn't too much extra matter mixed in and weigh the bags. The porters then run the food into the warehouse and stack it in neat rows and columns to form elaborate, sheer-faced structures as high as three-story buildings. On average last year porters like these across Uganda handled more than 1,000 metric tons of food — tens of thousands of bags, all loaded and unloaded manually — every single day. "Whatever comes in goes out almost immediately," says Konjit Kidane, the Ethiopian who is WFP's head of logistics for Uganda.

Kidane unfurls a map of the region upon which is printed rail and road routes, and the costs associated with each port and passage. The map was printed in 2006, so the printed prices are now out of date. But Kidane has bigger problems. As food and fuel prices rise, suppliers have begun defaulting on their contracts; they are either unable to provide goods at a previously agreed price because input costs have increased, or unwilling to sell food at the old rate now that others will pay more. "We used to have sufficient stock — four months, five months — in the pipeline," Kidane says. By May there were three, and the situation is only worsening.

Worldwide, WFP boasts that its overhead costs are no more than 7% of total operating budget. But today's food and fuel shortages don't just mean higher costs; they also introduce new elements of unpredictability to getting aid to those who need it. The day after distributing to Lokali parish, WFP officers in Karamoja are out again in nearby Moruongor. But the food trucks only trundle up to the distribution point at noon, three hours after recipients began gathering along the side of the dirt road. The reason for the delay: the weekend's diesel delivery never arrived from Kampala. "We spent most of the morning getting the little bit of fuel out of the other trucks so we could fill two to drive here," says Simon Okiseng, a senior field worker. "If the fuel doesn't arrive today, there will be no distribution tomorrow."

All this compounds the enduring logistical challenges that Africa presents for aid agencies: poor roads, unpredictable weather and political instability. After Kenya's disputed election in December, a U.S. shipment of 9,000 metric tons of sorghum was blocked for more than 100 days in Mombasa, with no safe way to get it out, Kidane says. Violence returned to Burundi after a ceasefire deal failed, so WFP must postpone plans to stop feeding Burundian refugees in Tanzania. WFP is sometimes a target of violence too. Darfur rations were cut by nearly half in May because too many trucks had been hijacked. Distribution was suspended briefly in Karamoja last year after cattle rustlers ambushed a convoy and shot dead the lead driver. The trucks, returning from a delivery, were all empty.

A Way Out
"I would say over the medium to long term, I am an optimist," Sheeran says in London, "because the world knows how to grow enough food." That may be so. But food aid is not devoid of controversy. On the one hand, of course, no one wants to see people starve. At the hospital where James Lemukol is superintendent, a mother cradles her 3-year-old son; he's always been too weak to learn to stand. Others arrive so swollen — their bellies distended and extremities bloated from the fluid that leaks out of weakened blood vessels — that medical staff have trouble finding veins for the IV lines needed to fight malaria or other opportunistic infections. But on the other hand, there has always been the risk that long-term food aid simply encourages populations to stay on land that can no longer sustain them.

WFP was not designed to fight the deeper roots of hunger. (Within the U.N. that task falls to other agencies, like the Food and Agriculture Organization and the U.N. Development Program.) But WFP can help. Its Food for Assets plan gives rations to displaced persons in northern Uganda who work to build and run local fish farms. Procurement officers can buy locally at above-market prices if they show that it helps to develop the country's agriculture. And, across the world, WFP feeds about 20 million schoolchildren each year. That service is designed both to help students concentrate in class and to give parents a reason to send kids to school in the first place. In some regions where girls' attendance is especially low, girls get bonus rations to take home.

These programs are vital to what WFP workers call the "exit strategy" — getting to a point where food aid is unnecessary. But as food prices rise and budgets become less predictable, programs like these are also the first to be slashed. Martin Devenish, an Irish priest who runs a technical college near Moruongor parish, is proud to be teaching trades that could bring industry to Karamoja: carpentry, tailoring and bricklaying. Today dozens of adult students sit at benches, eating their midday meal, mostly corn provided by WFP. But each time the priest turns on the radio and hears about possible food-aid cuts, "I'm thinking what about here!," Devenish says.

His students are able-bodied men and women; no one will die if WFP cuts this service. Already the agency has planned an end to school feeding for 500,000 kids in Uganda's camps. The picture is the same across the world. School feeding was canceled in Cambodia for a month this spring because of a shortage of funds. In Sri Lanka, a food-for-work scheme to maintain irrigation systems was axed for the same reason. "In a sense we're mortgaging the long term to pay for the short term," says John Aylieff, WFP's global head of programs in Rome.

Back in Moruongor, as the day gets to its hottest, two men shout that the hand-outs have gone all wrong. "The ones who need food most can't fight for it," says one, Losike John D'Porox. "Widows, orphans, they should be fed first." Then everyone else, he asserts, should be enrolled in food-for-work programs, improving the roads, digging water ponds and farming. "That's what can help people," he says — and he may be right. Long-term, WFP's only way out of Karamoja will come when the region is self-sufficient once again. Getting there will take a predictable budget, more security, and time for forward planning — all luxuries now. And yet as the sun beats down on the squabbling crowds, no one here claims that WFP's efforts have been wasted. "We're happy!" one woman says, and she whoops with joy as she gets set to pick up her rations. Today, at least, fewer are going hungry. But tomorrow, others will be standing in the hot sun, waiting for food.

• Laura Blue/Karamoja
• Every year the U.N.'s World Food Program feeds tens of millions of the planet's hungriest. Now, as food prices soar and even more people need constant help, its brief is more urgent than ever — and its budget more pinched