Malnutrition has become so severe in northern Nigeria that aid workers say it appears as if almost all the children under the age of five have died, the New York Times reports.

“We saw only older brothers and sisters. No toddlers straddling their big sisters’ hips, no babies strapped to their mothers’ backs," a representative from an aid group told The Times.

Doctors Without Borders, which sends volunteer medical professionals around the world to treat vulnerable populations, are starting to visit households in Nigeria's Borno State to deliver food items such as palm oil and peanut paste as a preventative measure. They've also extended the admission criteria for malnourished children, the organization explained on its website:

"Usually we just treat children with severe malnutrition in our programs but due to the lack of food we had to extend the admission criteria and to start also treating children under five suffering from moderate acute malnutrition in order to prevent them from falling into the severe form of acute malnutrition."

The Times reports that the need is so great that, instead of measuring the height and weight of children in need of hunger, they are simply measuring the circumference of their arms.

How did it get this bad?

Following years of conflict, the Nigerian army recently pushed members of the terrorist group Boko Haram out Nigeria's northeastern Borno State — but not before nearly two million Nigerians were internally displaced. The violence — in addition to bureaucratic obstacles — has prevented aid organizations from delivering food and resources to the affected communities. But according to the Times, tensions between aid groups and the government heavily contributed to the crisis. In particular, the Nigerian government has been slow to acknowledge the malnutrition problem and accused the United Nations of "exaggerating" the issue when it requested $1 billion in aid in December.

The humanitarian crisis has gone largely ignored, as "the world’s attention has been focused on refugees in Syria and North Africa," the Times' Donald McNeil Jr. wrote. The lack of attention has left the government and aid groups with limited means to address malnutrition, and health issues like malaria, measles, and diarrhea, which hunger exacerbates.

Humanitarian groups like the World Health Organization (WHO) and UNICEF have announced plans to increase aid to Nigeria in 2017, targeting food shortages and starvation.

"During the summer, we were overwhelmed by the number of malnourished children with severe complications who needed treatment,” Dr. Javed Ali of Doctors Without Borders wrote in a press release emailed to ATTN:. “Even though seasonal factors have now brought some respite, it does not mean that the emergency is over. Without a significant scale-up from national and international aid organizations, the situation could be even worse next year, as millions remain displaced by the conflict.”