Nurses treat an 18-year-old woman for severe acute malnutrition in Hodeidah.Abdul Jabbar Zeyad / Reuters

People rummaging through trash for food. Families subsisting on leaves. Children receiving medical attention far too late for them to be saved.

Such stories have become the norm in Yemen, where a nearly four-year civil war has left tens of thousands of people dead. The prolonged violence and the array of resulting crises have created what the United Nations says is the world’s worst humanitarian disaster. Half of the Yemeni population is considered to be on the brink of famine, with at least three-quarters reliant on humanitarian assistance, and aid workers have described scenes of increasing desperation as what little there is runs out.

The slow-moving catastrophe—and American involvement in it—has drawn increasing concern in the United States. On Wednesday, those objections were echoed in the halls of Congress, as senators voted decisively to open debate on a measure that would end American military support for the Saudi-led effort backing the Yemeni government. The United States is Saudi Arabia’s biggest arms supplier, and its equipment has been used in an air campaign that has devastated the country’s infrastructure and killed thousands of civilians. While opprobrium had been building for months over the humanitarian crisis, the debate has reached a crescendo following revelations of high-level Saudi involvement in the murder of the journalist Jamal Khashoggi.

“The two separate issues—the Yemen conflict and the Jamal Khashoggi murder—have become conflated,” said Gerald Feierstein, who served as U.S. ambassador to Yemen from 2010 to 2016. Legislators, Feierstein said, “are looking at Yemen as a way of putting pressure on the Saudi government.”

In many ways, American entanglement in Yemen mirrors the conflict itself: What started as an ostensibly local and limited engagement has since spiraled into something with no apparent end in sight.

The Obama administration began, somewhat reluctantly, to provide logistical and intelligence support for the Saudi-led air campaign in the spring of 2015. At the time, the White House cited the “instability and chaos” wrought by the Houthi rebellion, as well as the separate threat of al-Qaeda’s branch in the country. The Trump administration, by contrast, has portrayed the U.S. interest in the conflict as fundamentally about containing Iran, which backs the Houthis, and denying it a foothold on the Arabian peninsula.

Amid the outcry over Khashoggi’s killing last month, the United States suspended air-refueling support to the Saudis, but continues to provide intelligence and sell weapons to the country. It also, in late October, began pushing for talks to end the conflict.

“Fundamentally, I think the military campaign isn’t really going to resolve this matter,” Feierstein said. “The Houthis aren’t going to throw in the towel. So the only real play is to try to get the parties to the table and see whether they can’t come up with a political way forward.”

To hear aid workers on the ground tell it, though, the current situation isn’t just untenable—it’s bound to get worse. “It’s entire communities who have exhausted their coping capacities, not just families,” Scott Paul, who oversees Oxfam America’s policy advocacy in Yemen, said following his latest trip to the country last month.

The reason behind each and every one of the individual crises in Yemen—including a strangled economy, widespread food insecurity, and the largest cholera outbreak in modern history—is the political crisis that started it all. In September 2014, the Houthi rebels seized control of Yemen’s capital city of Sanaa, ultimately forcing the country’s leader, President Abd-Rabbu Mansour Hadi, into exile. Six months later, a Gulf coalition, led by Saudi Arabia and backed by the United States and the United Kingdom, launched a military campaign with the aim of restoring Hadi’s internationally recognized government and countering what it saw as Iranian influence in the region. The Houthis, backed by Tehran, fought back.

Now, nearly four years on, the conflict is at a stalemate. Though the Saudi-led coalition has been able to wrest back some of the Yemeni government’s lost territory, Sanaa and the key port city of Hodeidah remain under Houthi control.

A stalemate doesn’t mean that the country has become any less dangerous, though. Tamer Kirolos, the country director of Save the Children in Yemen, said that the ongoing bombardment of Hodeidah by Saudi-led air strikes has made access to humanitarian aid all the more difficult. “There are obviously issues around safety and security in access, especially close to the front lines,” he said, speaking by telephone from Sanaa. Access is even tougher for those in more remote areas of the country, particularly when there is no fuel available.

For average Yemenis, such circumstances ultimately lead to perpetual uncertainty. “To be on the brink of famine means you don’t know where your next meal is coming from,” Kirolos said. It’s a reality the UN estimates applies to some 14 million Yemeni people, and one which Save the Children warns may have resulted in the deaths of some 85,000 children under the age of five.

No corner of Yemen has been left unspared by the widespread food insecurity. Children rummaging through the trash for food and families subsisting on as little as green leaves have become all too common in the country. “A lot of the women we’ve spoken to who have been displaced, they were mothers and they had told us their daily consumption is black tea and one piece of bread,” said Shabia Mantoo, a spokeswoman for the UN’s refugee agency who spent two years in Sanaa. “They’ve run out of their savings, they’ve exhausted everything they had that could sustain them.”

Those who have savings aren’t much better off. The sharp depreciation of the Yemeni rial—which, compared with its prewar value of 215 rials per U.S. dollar, dipped as low as 800 rials per dollar last month—has made basic necessities prohibitively more expensive. “Food is out there, it’s in the markets, everywhere you can see it,” Sukaina Sharafuddin, a Yemeni aid worker with Save the Children, said by telephone from Sanaa. “They just cannot afford to buy it.”

And it’s not just food that’s become more expensive. “The other day, I bought a painkiller—just a simple painkiller for a headache,” Sharafuddin said. “It cost 1000 rials. That’s like a week’s income for a six-member family.”

This means that most Yemenis are not only priced out of affording food or essential medicines, but they are also unable to pay for the cost of travel to the country’s few remaining health facilities. And even if they make the trip, they often find clinics and hospitals unable to offer treatment. “A lot of people walk in, and they walk right back out again because the severe cases can’t even be handled there,” said Paul, the Oxfam aid worker. Yemenis tending to ailing children then face an impossible decision: Spend even more to travel to another facility, in the hope of finding treatment, or marshal their few remaining resources for the rest of the family.

“Every parent in Yemen everyday wakes up and has to make Sophie’s choice,” Paul said, “because there’s no way to look after every member of the family in a responsible way.”

There are, once again, hopes for a ceasefire, and Britain is putting forward a resolution at the UN Security Council calling for the unhindered flow of food and medical aid to the country. Martin Griffiths, the UN special envoy to Yemen, is spearheading diplomatic efforts to bring the warring sides to Sweden for peace talks next month. He voiced optimism when he told the Security Council this month that the conflict was no longer the “forgotten war” it’s been thought to be.

For the Yemeni people, however, there is little appetite for optimism. “The way they see it,” Paul said, “nobody cares about them.”

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