From her obex beneath the rotting corpse of the First Titan, a goddess known as Mother Pestilence rules over an endless dust bowl that once was an azure sea teeming with fish the size of carriages. For centuries, the civilizations along the edge of her wasteland have offered Mother Pestilence tribute–the surplus of their harvest–as a show of humility before the ever-present threat of scarcity, disease, and hunger.

Every few decades, a society decides to buck superstition and turn its back on Mother Pestilence. Instead of humbling themselves and rendering unto her an offering, they choose to gorge on their surplus, flaunting the efficacy of their sprawling cage farms and intricately dug irrigation canals. These societies often do not last, as Mother Pestilence sends her daughters, the hands of drought and famine, to remind them of how precious game, livestock, and water truly are. Within weeks, these impious outposts are reduced to a cluster of abandoned temples, empty bazaars, toppled monuments, and piles of the cannibalized dead.

HAND OF DROUGHT AND FAMINE

A pair of conjoined twin sisters clothed in wrappings shambles from the dust, a basket of stale bread and rotting fish dangling from their arms. A veil covers four pupil-less eyes and lips pierced with ruby studs.

Double-strength 5th-level spoiler [HUMANOID]
Initiative: +8
Immunity: poison

HP 75 AC 21
PD 17 MD 17

Hunger and Thirst – The hand of drought and famine makes one brand of endless hunger attack and one mark of endless thirst attack.

Brand of Endless Hunger +13 vs. PD – 25 damage and ongoing 10 damage (save ends).
Natural 18+: The target contracts the blight of Mother Pestilence.

Mark of Endless Thirst +13 vs. PD – 15 damage.
Natural even miss: The hand of drought and famine makes a cry of drought attack.
Natural 16+: The target cannot drink potions (save ends).

R: Hurl Rotting Food +13 vs. PD (2 attacks) – 25 poison damage.
Natural 16+: The target is weakened (save ends).

[Special Trigger] C: Cry of Drought +13 vs. MD (nearby enemies) – 25 thunder damage. In addition, choose up to 2 potions carried by enemies damaged by this attack. The potions spoil, turn to dust, or are otherwise rendered useless.

C: Chant of the Starving Temple +13 vs. MD (nearby enemies) – 40 poison and thunder damage. In addition, name one game animal, livestock animal, or crop that exists in the mortal world. It goes extinct.
Limited use: 1/battle, as a quick action. The hand of drought and famine must be staggered to use this attack.

Blight of Mother Pestilence: PCs affected by the blight of Mother Pestilence that use a recovery during a quick rest regain only half the normal number of hit points. The blight is cured if the affected PC consumes the flesh of another member of their race.

Escalating Hunger Pangs: The PCs take a penalty to saving throws equal to the escalation die.

TREASURE

When the hand of blight and famine is slain, the PCs may claim the following rewards in
addition to any treasure they would normally earn:

• Beneath the wrappings is an ankh shaped from petrified wood. A living creature that wears the ankh no longer needs to eat or drink and is immune to the effects of disease or poison (though they may still become a carrier of contagion).
• The wrappings around the hand’s upper left arm are a scroll that, when read aloud, allows the party to name one village, settlement, citadel, or small city anywhere in the planes. All food in or near the named location becomes dust, and the location suffers pestilence and famine for a year and a day.
• The wrappings around the hand’s heads are a scroll that, when read aloud, allows the party to call forth the corpse of any mortal that has ever died. The PC who eats the rotting heart of the corpse gains one valuable piece of knowledge the deceased would have had in life. You might prepare a piece of knowledge relevant to the adventure, or you might ask the PC to invent one.