By Jonathon Burch

KABUL, Jan 31 (Reuters) - The United States must change its strategy in Afghanistan if it is to avoid a humanitarian crisis, with millions of Afghans struggling to survive and violence at its worst levels since 2001, an aid group said on Saturday.

After almost three decades of war, Afghanistan remains one of the poorest and least developed countries in the world. Drought and high food prices have also hit many Afghans hard.

On top of that some 5,000 people, including more than 2,000 civilians, were killed in 2008 and insurgent attacks were up by 50 percent on the previous year.

"With spreading insecurity, and civilians facing critical needs, there must be a comprehensive new strategy which will avert a major crisis," Raymond Offenheiser, president of Oxfam America, a British-based charity said in a statement.

In a memo sent to U.S. President Barack Obama, Oxfam, which has worked in Afghanistan for more than 20 years, outlined a 10 point plan aimed at changing U.S. policy that if adopted, it says, will help bring lasting peace and development.

Washington is conducting a major review of strategy in Afghanistan and is expected to deploy up to 30,000 more U.S. troops and commit much bigger development assistance.

But instead of focusing on military efforts, the United States and other donors should step up their humanitarian assistance and concentrate on long-term solutions as opposed to quick fixes, Oxfam said in its memo to Obama.

"With faltering reconstruction and rising instability, the United States must look beyond military solutions and take a leading role in protecting civilians and forging a new international approach to Afghanistan," Offenheiser said.

While the United States is by far the largest donor to Afghanistan pouring billions of dollars in aid into the impoverished country, humanitarian assistance is dwarfed by that spent on military operations.

The U.S. military alone spends some $100 million a day fighting Taliban insurgents, but spending on aid by all donors since 2001 amounts to only $7 million a day, aid agencies say.

In 2007, U.S. funding for the agricultural sector was less than 1 percent of what it spent on security, despite 80 percent of Afghans relying heavily on agriculture to survive, said Oxfam.

Up to five million Afghans face food shortages this year and more than a million young children and half a million women face serious health risks due to malnutrition, it said.

Only half of a United Nations emergency appeal for $404 million for Afghanistan, launched last July, has been funded. (Editing by Sanjeev Miglani)

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