Rates of malnutrition are “skyrocketing” in South Sudan, humanitarian relief agency Medair said Tuesday, calling widespread hunger “a threat more dire than the violence itself.”

Malnutrition in Maban County in Upper Nile State has tripled since February, Medair said in a press release.

“Food was scarce even before the conflict started; now it is all but gone. We are seeing people climbing trees to pick leaves to eat and wading into murky swamps to consume water lilies,” Medair communications officer Wendy van Amerongen said.

The United Nation’s humanitarian arm, UNOCHA, reported last week in its humanitarian bulletin that refugees are leaving Maban for Sudan’s Blue Nile State because of food shortages.

In southern Unity State, about 600 families have moved from Ganyiel to Amongpiny, Rumbek Centre County in search of food.

South Sudan’s six-month conflict has disrupted the planting season and hindered food deliveries, especially in Jonglei, Upper Nile, and Unity States where fighting has been most intense.

UNOCHA said that since January in South Sudan nearly 30,000 children under five years old have been treated for severe acute malnutrition, with 1%, or over 200 children, dying.

The agency said there are gaps in malnutrition prevention programs in those three war-affected states, and that infant and young child feeding education activities must be scaled up.

Medair warned that famine is a “real possibility” by year’s end.

“If the crisis reaches that level, the eyes of the world will be on South Sudan, and everyone will ask why we didn’t do more to stop it,” said Jim Ingram, Medair CEO. “This is our window of opportunity. We need the world to know this is happening and give them a chance to take a stand.”