Relief groups made a new plea to the United States to offer food assistance to North Korea, warning that hunger was worsening and could develop into a major crisis next year. The United States earlier this month gave flood relief to North Korea, with which it has tense relations, but it has held off from approving food shipments due to concerns that the communist regime will use the aid for political ends. The five US aid groups which delivered the flood aid said they monitored distribution to civilians and were alarmed at what they saw in North Korea as heavy rains and winds had destroyed buildings, crops and roads. "Health and food security, always fragile in North Korea, are deteriorating and people are vulnerable," Matt Ellingson of Christian relief group Samaritan's Purse said in a joint statement by the five organizations. "Already hungry children have been pushed over the edge by continued food shortages and diarrhea caused by dirty water and poor hygiene," he said. "Without immediate and direct intervention there is significant risk for a far greater crisis to unfold in the coming six to nine months," he said. Hundreds of thousands of North Koreans died in a famine in the 1990s. The relief groups said they did not understand why President Barack Obama's administration has not given a response to their calls made months ago for a food aid program focused on women and children. "Many innocent people are at risk today, and we know that food aid can save lives," said Jim White of Mercy Corps. The Obama administration has repeatedly said that no decision has been made on food aid. Robert King, the US special envoy for human rights on North Korea, visited in May and said the regime must ensure tight monitoring of aid. Many members of the rival Republican Party adamantly oppose food aid to North Korea, charging that the aid would prop up Kim Jong-Il's regime as it prepares for a national celebration next year and diverts resources to its nuclear program. The Republican-led House of Representatives voted in June to bar US food assistance to North Korea. But the Democratic-led Senate removed similar language as they moved ahead this month with an appropriations bill. The Obama administration has opened talks with North Korea but has insisted that the communist regime needs to commit clearly to past agreements to give up its nuclear weapons and to improve relations with US-allied South Korea. A senior administration official recently said that the United States was waiting for clearer signals from North Korea. "The United States, along with other nations, has made a modest contribution to flood assistance. And I think it would be fair to say that we are still awaiting a clear signal from Pyongyang about what their response is to our overall proposals," the official said on condition of anonymity. The US government said it granted $900,000 in flood relief. The private relief groups pooled together their own resources and said the cargo plane included more than $3 million in supplies including oral rehydration salts, tarps and ready-to-eat foods. The aid groups distributed food aid to North Korea in 2008 and 2009 until the regime abruptly expelled them.