Following the worst harvest in a decade, the Republic of North Korea is facing a catastrophic food shortage, leaving an estimated 10.1 million people severely food insecure.

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The country’s agricultural output was greatly impacted by a combination of droughts, flooding, and heatwaves that have caused a food deficit of 1.36 million tons of crops.

As a result, the government has cut food rations to less than 11 ounces a day, the United Nations found during an investigation between March 29 and April 12.

Most North Koreans live in extreme poverty, according to the Borgen Project, an anti-poverty organization. More than 18 million North Koreans, including 1.3 million children, depend on food aid to avoid malnutrition, according to a UN report.

Some families have gone without protein for weeks and months at a time, a situation that can lead to severe malnourishment and health problems, especially among children who become at risk of stunting.

The abysmal harvest recalls the famine of the the mid-1990s that killed 3 million people.

The country’s emerging food crisis is made worse by shortages of fuel, fertilizer, and tools for farming, and the UN expects the situation to become worse in the months ahead.

“Prospects for the 2019 early season crops of wheat and barley are worrisome, with communities at risk as the lean season gets underway in June,” Herve Verhoosel, World Food Program spokesman, told Reuters.

North Korea currently faces debilitating economic sanctions that have prevented humanitarian aid from flowing to the country. The UN has recently called for countries to override these sanctions to provide food assistance to the starving population.

“This is a serious issue and children are going to be severely impacted if we do not do something by the time the lean season truly kicks in by June,” David Beasley, the head of the UN World Food Programme, told the Guardian. “Russia has responded and is sending in 50,000 metric tonnes [of wheat], China is doing something too. Western donors are still hoping that the [breaking] of the impasse will take place so that everyone can come in together.”

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