Roughly one in 10 people in Ethiopia, or more than 10 million people, will not have enough food to eat next year.
The shortage comes due to the effects of a crippling drought made worse by the El Nino weather phenomenon, Save the Children said.
Fields growing sorghum, maze and teff, an important local grain, across much of the landlocked east African nation have dried up due to the successive failure of seasonal rains, said said John Graham, Save the Children's country director.
More than half of the 10.1 million people expected to need emergency food assistance are children, he said.
El Nino is a warming of ocean surface temperatures in the eastern and central Pacific that occurs every few years, triggering scorching weather in east Africa and in Asia as well as heavy rains in South America.
Experts say the impact of El Nino, which has begun and will stretch into 2016, could be the worst on record since 1997-98.
Its effects have been particularly punishing on pasture areas in the east and crop land in Ethiopia's north and east, Graham said.
In his 18 years working in Ethiopia, "this is the worst drought I've seen," Graham told the Thomson Reuters Foundation.
Necessary aid to Ethiopia could cost an estimated $US1.4 billion, he said.
Ethiopia suffered an infamous famine in 1984 that killed hundreds of thousands of people and crippled the country.
In 2011, a severe drought that effected Ethiopia, Kenya, Somalia and Djibouti caused severe malnutrition and the widespread death of livestock, according to Oxfam International, a British-based confederation of anti-poverty organizations.
International development economist Courtenay Cabot Venton warned that response to Ethiopia's looming hunger problem could be slow despite the dire outlook.
"People don't respond until they see a starving child. It's very hard to go and take a picture of a field of crops that's dying and compel people to give money," said Cabot Venton, an independent consultant who has worked extensively with aid agencies in Ethiopia.
Despite Ethiopia's fast-growing economy, some 44% of children under 5 years old there suffer severe chronic malnutrition, according to the US Agency for International Development (USAID).
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