Consecutive seasons of failed rains, exacerbated by a rapidly growing population, rising inflation, endemic poverty, and limited government capacity, have led to chronic food insecurity and water shortages in Ethiopia. Approximately 7.2 million people receive food or cash assistance through the Government of the Federal Democratic Republic of Ethiopia (GFDRE) Productive Safety Net Program (PSNP), which is funded by multiple donors. The delayed onset and poor performance of the March to May belg rains, combined with the failure of the previous two consecutive rains, has resulted in below normal harvests and diminished pasture throughout Somali, Oromiya, and Southern Nations, Nationalities, and Peoples (SNNP) region s. Significant humanitarian challenges, including flooding, conflict, malnutrition, acute watery diarrhea (AWD) outbreaks, delayed food response, and locust and armyworm infestations, confront populations in many areas of the country. This document is report # 4 for Fiscal Year 2009.