AL HARF, Yemen — The mother’s first challenge when her spindly 8-month-old son came down with a fever, diarrhea and vomiting was to get from their poor, isolated village in northern Yemen to the nearest clinic.
After three days of failing to find a ride, she set out on foot, carrying her sick child for two hours to reach the medics who immediately recognized yet another case in Yemen’s spiraling crisis of acute malnutrition.
Even after a week of treatment with enriched formula, the boy, Sharaf Shaitah, lay motionless on a hospital bed, his bones peeking through the skin of his twiggy limbs. Asked if her family had enough to eat, his mother, Iman Murshid, replied, “Sometimes we have enough, sometimes we don’t.”
Six years into a war that has killed hundreds of thousands of people, shattered the country and battered much of its infrastructure, Yemen faces rising rates of hunger that have created pockets of famine that aid groups warn are likely to grow, leaving even more malnourished Yemenis vulnerable to disease and starvation.
The war has led to chronic food shortages in what was already the Arab world’s poorest country. A widespread famine was averted in 2018 only by a large influx of foreign aid. But the threat is greater this time, aid groups say, as the war grinds on, families grow poorer and the coronavirus pandemic has left donor nations more focused on their own people.
“The famine is on a worsening trajectory,” said David Beasley, the executive director of the World Food Program, in an interview after returning recently from Yemen. “Our biggest problem now is lack of money — and the war. Six years of war has completely devastated the people in every respect.”
Nearly half of Yemen’s population, 13.5 million people, are struggling to get enough food, according to the United Nations. That number is expected to rise by nearly three million by the end of June, largely because funding shortfalls have reduced how many people aid agencies can feed.
The United Nations says that 3.6 million Yemenis are already in an “emergency” stage of food shortage, and 16,500 have reached “catastrophe.” It estimates that 400,000 children are at risk of dying of hunger.
“If we don’t get them on full rations soon, I just don’t imagine we won’t have a full-scale famine,” Mr. Beasley said.
Yemen has been on a downward spiral since 2014, when rebels allied with Iran and known as the Houthis seized the country’s northwest, including the capital, Sana, sending the government into exile.
In 2015, a coalition of Arab countries led by Saudi Arabia and backed by the United States began a bombing campaign aimed at ousting the Houthis, but the war settled into a stalemate, with competing administrations in the north and south and attacks frequently killing civilians.
Aid groups have reported that coalition airstrikes, often using American munitions, have been the leading direct cause of civilian casualties, killing thousands of people. In 2019, Congress voted to end U.S. support for the Saudi-led campaign, but President Donald J. Trump vetoed the measure.
Within days of taking office, President Biden froze some arms sales to the coalition and halted intelligence and logistical support for it. He has appointed a high-level envoy to push for peace talks, and Saudi Arabia has announced a new peace plan, but those efforts have yet to make concrete progress.
The growing hunger crisis stems from the wider breakdown of Yemen’s economy during the war, experts say. The United Nations estimates that the war has claimed more than 200,000 lives, mostly from indirect causes like hunger and disease.
The shattering of the country has displaced millions of people, separating them from their livelihoods and leaving them dependent on aid. Even people who still have jobs have been left destitute. The competing governments in the north and south have struggled to pay salaries, and a drop in the value of Yemen’s currency has rendered imported products unaffordable in a country that imports nearly all of its food.
Economic slowdowns in wealthy Gulf countries have cut into remittances sent home by Yemeni expatriates, an economic lifeline for many families. An air and sea blockade by the Saudi-led coalition on Houthi-controlled territory has restricted imports of vital goods like fuel.
Aid groups warn that spreading hunger contributes to health problems that Yemen is not equipped to deal with, especially among children, and that more people could end up dying from illnesses exacerbated by hunger than from the war itself.
“The truth is that people don’t have enough food and they can die from causes related to that,” said Bismarck Swangin, a spokesman for UNICEF in Yemen. “When you say famine-like conditions, people’s bodies are collapsing because they don’t have enough food.”
The crisis has fallen hard on rural clinics in areas battered by war.
The clinic where Ms. Murshid brought her son, the Harf Sufian Rural Hospital, about 85 miles north of Sana, receives as many as 40 malnutrition cases per month.
Its medics have only six beds for malnourished children and treat them with enriched formula and vitamin supplements provided by aid organizations. But they lack antibiotics to treat associated infections and isolation rooms to prevent children with measles or respiratory infections from passing them to other patients.
The clinic also lacks an intensive care unit for children who arrive there in critical condition. Many of them don’t survive long enough to reach better-equipped facilities.
“Most cases die due to the lack of an I.C.U.,” said Muhammad al-Qadhi, a nutritionist, flipping through photos of bony children with hollow eyes who have died in the clinic.
The number of malnutrition cases the clinic handles has climbed steadily, said Abdulelah Otilah, the director, but its services have been jeopardized by funding cuts by international aid groups. The clinic has not received a fuel shipment since December and is down to its last 60 liters of diesel for the electricity generator that powers incubators for premature babies.
Unless more fuel arrives, “death then looms large,” Dr. Otilah said. “We can’t help but ask God for support.”
Yemen faced the threat of famine in 2018, prompting large donations from countries including the United States, the United Arab Emirates and Saudi Arabia, which also allocated $2 billion to support Yemen’s central bank.
Those measures pulled the country back from the brink, but without solving Yemen’s underlying problems. Early last year, when donor countries were shifting their focus to protecting their own populations and economies from the coronavirus pandemic, the aid budget for Yemen fell short again and hunger increased.
A U.N. pledging conference on March 1 aimed to raise $3.85 billion to help Yemen avoid famine. But participating countries committed less than half that much, $1.7 billion, forcing U.N. agencies to scale back their plans.
“Cutting aid is a death sentence,” the U.N. secretary general, António Guterres, said of the outcome.
Rafat al-Akhali, a fellow at the Blavatnik School of Government at Oxford University who studies Yemen, said that frustration with the lack of progress toward ending the war, questions about the efficacy of the United Nations and concerns about Houthi interference with aid delivery had all contributed to reduced donations.
Foreign aid can help Yemeni families avoid catastrophe, he said, but only an end to the war can ease Yemen’s many crises.
“The real solution is for the conflict to stop and for some semblance of normality to be restored, but without that what are you left with other than aid coming in from U.N. agencies or an injection of cash?” he said.
In another rural clinic near the town of Qaflat Athr, also north of Sana, Amna Hussein, 15 months old, lay weakened by diarrhea and vomiting linked to malnutrition. She had been treated in the same clinic last year and had improved, her mother said, and they had returned each week for nutritional supplements to keep her healthy. But last month, because of funding cuts, the supplements ran out and now Amna was back in the clinic.
Her mother, who declined to give her name because of shame, said that she and her four daughters had left her husband and moved in with her brothers, who had barely enough to feed them.
“We are like refugees in other people’s home,” she said. “You can only appreciate whatever is provided.”
Shuaib Almosawa reported from Al Harf, Yemen, and Ben Hubbard from Beirut, Lebanon. Rick Gladstone contributed reporting from New York.