I've worked in that environment (not that famine, I was only a teen). Negotiating with the local powers that be.
It is incredibly complex, and difficult to weigh up the advantages vs disadvantages to the local population.
The alternative is to be a purist, and let people starve.
People survived because of the Live Aid money. Other chunks of it were used to continue the conflict.
The reality is for aid orgnaisations - as faced by them today e.g. in Gaza - is that you either give up on the civilian population and leave them to die, or you negotiate access and support with regimes you would prefer did not exist.
Personally I think it is a cop out to wash your hands of a situation and let people die.
The alternative is to do what you can, continually balancing the harm and the good you are potentially doing. Far more challenging, and there are no easy answers.
And all too easy to sneer at by the people who don't get involved.
Just as friends working in the homeless sector have to continually balance the support they offer to many of the homeless with tough love. Many of their service users have substance abuse problems, and/or untreated mental health problems. Those who are easy to rehouse tend to get something fairly quickly. Then you have the people who are not attractive tenants - but they still deserve care.
If they get enough support they might find enough within themselves to make it into a better life for themselves. However, there will be blips on the way. The people supporting them have to continually make judgements about when to draw the line and when to evict.
There are no simple answers