Drought and famine-blighted Somalia is at a "turning point" as conditions decline with hundreds of thousands more people likely to die in coming months, 20 aid agencies warned on Wednesday.

The situation was the worst ever seen by the group of international and Somali non-governmental organisations (NGOs) and was expected to deteriorate further, they said.

"As NGOs who have worked in Somalia for decades, we are accustomed to the daily struggle to survive that is the reality for most Somalis," they said in a letter released on Wednesday, warning upcoming rains would add to the misery.

"However, never before have we faced such acute suffering with so many lives at stake. Somalia is at a turning point."

International agencies that signed the letter included Oxfam, International Rescue Committee, ACF International, Caritas Switzerland, World Vison, Medecins du Monde France, Danish Refugee Council and Mines Advisory Group.

The United Nations has declared six regions in south Somalia famine zones.

The letter also repeated an earlier United Nations' warning that 750,000 people faced death from starvation in the next four months.

"It is hard to imagine that the suffering in Somalia could get any worse," the letter by the aid agencies added.

Yet rains expected next month "will result in increased suffering and lead to the deaths of many more weak and vulnerable Somalis in communities already decimated by famine," it said.

"The spread of cholera, measles and malaria will have a devastating effect on malnourished men, women and children."

Restrictions on the emergency aid delivering is blocking efforts to support those in need in Somalia, the aid agencies added, calling for "free passage of assistance."

Extremist Shebab fighters pulled out of positions in the war-torn capital Mogadishu last month but still control swathes of south and central Somalia.

Their draconian aid restrictions are blamed for exacerbating harsh drought into famine in areas they control.

Drought, high food prices and fighting in Somalia has increased the number of those in need of humanitarian assistance across the Horn of Africa to 13.3 million, according to the UN.

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