Six months after the global humanitarian community swung into crisis mode, 13 million people in drought-stricken East Africa have avoided disaster but still need emergency assistance.

“Some significant improvement” has been achieved in easing what remains one of the world’s most severe humanitarian crises, according to Bruce Wharton, deputy assistant secretary of state for public diplomacy in the State Department’s Bureau of African Affairs. Still, he said, “this crisis is not over yet; the need remains great.”

Wharton and two other U.S. officials spoke to journalists in a teleconference January 24. The United States remains the largest donor to the region, with about $870 million in assistance given over the last year and a half. The U.S. officials praised the generosity and hospitality extended by Ethiopia and Kenya in providing refuge and assistance for Somalis. Famine has driven millions of Somalis off their lands in search of help.

Acting Assistant Secretary of State for Population, Refugees and Migration David W. Robinson said that without the support of the Kenyans and Ethiopians, many more Somalis would have died in famine conditions.

“Kenya already was host to hundreds of thousands of Somalis who had fled over the years” due to conflict and insecurity at home, Robinson said. “And in 2011 alone, an additional 300,000 Somalis fled into Ethiopia and Kenya, bringing the total of displaced Somalis in the Horn of Africa to somewhere around 955,000 people.”

The humanitarian effort in Somalia has been impeded from the beginning by threats of violence and attacks mounted by al-Shabaab, an organization designated as a terrorist group by the U.S. State Department. The group has denied access to areas under its control for humanitarian organizations attempting to provide relief.

Nancy Lindborg, assistant administrator for democracy, conflict and humanitarian assistance at the U.S. Agency for International Development (USAID), said al-Shabaab’s action to expel 16 humanitarian groups is a “complicating factor … which is a potentially grave concern.”

Al-Shabaab’s standing threat has inhibited the activities of humanitarian organizations. “Many of our activities are on a lifesaving, life-sustaining basis,” Robinson said. “The activities that we normally pursue in protracted refugee situations, including livelihoods, education and other things, are on a very limited basis at this moment” because of the security challenges.

U.S.-backed humanitarian activities in neighboring Ethiopia and Kenya do not face the security challenge and are moving forward with programs to alleviate the suffering and to better prepare the population for the region’s climatic conditions that blight the land and cause repeated humanitarian disasters.

Lindborg said the United States and the World Bank have been working with the government of Ethiopia to help pastoralists achieve a greater level of self-sufficiency to withstand hardship years. An estimated 7.5 million people have avoided a state of emergency because of these programs.

In Somalia, the mobilization of assistance that USAID began leading in July 2011 has produced results, Lindborg said. “The 750,000 people in famine conditions had gone down to 250,000 people” as of November, and in three of the six Somali areas designated as famine zones, the severity of famine has been lessened.

Disease can all too often become the second act for famine as malnourished people move to crowded camps in search of sustenance. The U.N. refugee agency expressed concern January 24 about two suspected cases of polio in Ethiopian camps sheltering Somali refugees. Samples have gone to a laboratory in Addis Ababa to confirm the polio diagnosis.

“Once the strain of virus is identified, the appropriate vaccine will be dispatched to Dollo Ado [the location of the camps] for a mass vaccination campaign in the camps and surrounding communities,” U.N. High Commissioner for Refugees (UNHCR) spokeswoman Melissa Fleming said in comments to the press at UNHCR’s headquarters in Geneva.

Fleming said UNHCR and other agencies working in the camps are stepping up their disease-surveillance activities to make sure any further cases of the contagious disease are detected. Heightened attention will also focus on clean water and sanitation to eliminate those possible routes of transmission for the polio virus.

While donor nations and humanitarian organizations must remain focused on the immediate needs of people in East Africa, U.S. assistance efforts also focus on the longer view. Lindborg cites the Obama administration’s Feed the Future initiative. “The goal is to help those communities that are in chronic food deficits and always teetering on the edge of crisis to be able to move into a more productive future and get on that pathway to development,” she said.

Assistance programs and humanitarian aid are not a long-term solution for Somalia, however. “The answer to humanitarian crises in Somalia is going to be the establishment of secure and stable governance,” Wharton said, “governance that respects human rights and the basic needs of the population.”