Despite a massive increase in humanitarian operations and international funding since famine was formally declared, the relief effort in Somalia is expected to miss almost all its key targets for 2011. Access and security have presented considerable challenges. According to the UN, malnutrition rates have more than doubled, less than 60% of the 3.7 million people targeted have received monthly food assistance, and only 58% of a targeted 1.2 million people received critical non-food aid items. Clashes between Kenyan troops and al-Shabaab threaten to further complicate difficulties surrounding humanitarian access. Relief groups fear that rising military tension will jeopardise aid efforts in central and southern Somalia, where humanitarian access is already difficult.