Yemen’s humanitarian situation was already grim before the country fell back into full-blown civil war this month. Now, the renewed fighting between the Iran-backed Houthi rebels and Saudi-backed government forces is exacerbating long-running challenges. Top aid organizations are raising grave concerns about the conditions that millions of Yemenis are facing while warning that growing insecurity on the ground and inadequate funding are making it difficult to deliver assistance.

Carl Skau, the acting executive director of the World Food Program (WFP), told Foreign Policy last week that the situation in Yemen was a “huge concern.” Skau visited Yemen several weeks ago to draw attention to “what we feared” could happen, but he said he “couldn’t have imagined” the “scale and the speed of the escalation since.”

The fighting is further complicating the operating environment in Yemen because the Houthis are “not respecting the basic rules of the game, in terms of privileges and immunities of humanitarians, of U.N. agencies,” Skau said. The Houthis have detained “38 of our WFP colleagues” in Sanaa, he added, and occupied its offices in the port city of Mokha. These conditions have made it “very difficult for us to operate there now,” Skau said.

A devastating civil war broke out in Yemen in 2014, but a 2022 truce had largely brought a halt to the fighting. That truce has since unraveled. In early September, the Houthis launched a blistering offensive and made major territorial gains along Yemen’s Red Sea coastline, securing effective control over the Bab el-Mandeb. But fighting began picking up steam weeks before that, with dire consequences for the civilian population.

More than 145,000 people have been displaced in Yemen since June, according to the International Organization for Migration. The World Health Organization (WHO) in a statement this week warned that displaced families face “rising risks of cholera, measles, malaria and dengue, and disrupted maternal, mental health and chronic care.” There have been more than 800 deaths in Yemen since early August amid the renewed fighting, the WHO said, and casualties were rising at a rate of roughly 100 per day between Sept. 19 and 26.

“People are scared, there’s a lot of violence, but they’re also entering a situation where everyone is depleted,” said Tjada D’Oyen McKenna, the CEO of Prosper Global, a humanitarian organization. “At their weakest moments, they’re facing yet another trauma,” McKenna told Foreign Policy, noting that the situation is especially hard on people who have “already been displaced multiple times” and are now “facing moving again into other areas.”

On top of the potential for further displacement, Skau is also concerned about further disruptions to maritime trade. The disruptions to shipping traffic brought on by the Iran war in the Strait of Hormuz and the Russia-Ukraine war in the Black Sea are already “adding pressures to food prices around the world,” Skau said. “The poorest who are already spending all their money on food are eating less, and we are anticipating that tens of millions of people will be pushed into acute hunger because of that.”

This is an especially big problem for Yemen, which imports around 90 percent of its food. More than 18 million people in the country face acute food insecurity, and 2.2 million children under age 5 face acute malnutrition, according to WFP data.

As the problem compounds, humanitarian organizations are increasingly worried about funding. “Yemen is one of the three countries where the U.S. has cut all their funding, so it was already a place where we were struggling,” Skau said.

A few weeks ago, Skau visited camps in Aden for internally displaced people where WFP has had to cut rations, and he said he was already seeing negative consequences, such as mothers leaving children behind in search of day labor in order to be able to bring back “some rice in the evening.” The situation has also led young men to consider joining the “armed struggle” to “make a little bit of money,” he said, which is an example of how “hunger or desperation also drives these conflicts.”

Only 20 percent of the humanitarian response needs are funded in Yemen, McKenna said.

“In Yemen, we’ve all been rationing for a while,” McKenna said, underscoring that it’s “always been one of the most underfunded crises.”