One in three people in northern Ethiopia are facing extreme hunger, the UK-based charity Oxfam says.
That's a total of almost 10 million people in the regions of Tigray and Amhara.
Conflict and drought have significantly reduced harvest forcing millions to resort to what the charity calls "unimaginable ways" to survive.
A report by a federal government agency said nearly 400 people have already died in the two regions due to starvation.
Unless relief efforts are scaled up, Oxfam is warning that northern Ethiopia could see a worsening humanitarian catastrophe.
A gap in funding and ongoing conflicts in Amhara have made humanitarian responses difficult.
Last year, the UN managed to get only a third of its $4bn (£3.2bn) appeal for Ethiopia.
Officials in Tigray say famine is looming, but the federal government has dismissed the possibility of famine.