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Multi-hop wireless networks employing random access protocols have been shown to incur large discrepancies in the throughputs achieved by the flows sharing the network. Indeed, flow throughputs can span orders of magnitude from near starvation to many times greater than the mean. In this paper, we address the foundations of this disparity. We show that the fundamental cause is not merely differences in the number of contending neighbors, but a generic coordination problem of CSMA-based random access in a multi-hop environment. We develop a new analytical model that incorporates this lack of coordination, identifies dominating and starving flows and accurately predicts per-flow throughput in a large-scale network. We then propose metrics that quantify throughput imbalances due to the MAC protocol operation. Our model and metrics provide a deeper understanding of the behavior of CSMA protocols in arbitrary topologies and can aid the design of effective protocol solutions to the starvation problem.