(theguardian) -- Seven million people are on on the brink of famine in war-torn Yemen, which was already in the grip of the world’s worst cholera outbreak when coalition forces led by Saudi Arabia tightened its blockade on the country last week, stemming vital aid flows.

Al-Thawra hospital, where Abdulaziz is being treated, is reeling under the pressure of more than two years of conflict between the Saudi-led coalition and Iranian-backed Houthis. Its corridors are packed, with patients now coming from five surrounding governorates to wait elbow-to-elbow for treatment. 

Less than 45% of the country’s medical facilities are still operating – most have closed due to fighting or a lack of funds, or have been bombed by coalition airstrikes. As a result, Al-Thawra is treating some 2,500 people a day, compared to 700 before the conflict escalated in March 2015.

More than 200 miles away in the southern governorate of Lahij, territory under the control of the coalition, more emaciated children lie listless, gasping for every breath.

These scenes are replicated in therapeutic feeding centres in the capital, Sana’a, and at the heart of the conflict-ravaged city of Taiz. There in the shadows of a single incandescent bulb, what appears to be a blanket bundled into a dark corner is in fact three month-old Elias Basem, who has spent 20 days of his short life being treated for severe malnutrition.

Aid agencies are now warning that Yemen’s already catastrophic humanitarian crisis could soon become a “nightmare scenario” if Saudi Arabia does not ease the blockade of the country’s land, sea and air ports – a move that the kingdom insists is necessary after Houthis fired a ballistic missile towards Riyadh’s international airport this month.

United Nations humanitarian flights have been cancelled for the past week and the International Committee of the Red Cross (ICRC), along with Médecins Sans Frontières (MSF), have been prevented from flying vital medical assistance into the country. More than 20 million Yemenis – over 70% of the population – are in need of humanitarian assistance that is being blocked.

Following international pressure, the major ports of Aden and Mukalla were reopened last week for commercial traffic and food supplies, along with land border crossings to neighbouring Oman and Saudi Arabia, but humanitarian aid and aid agency workers remained barred from entering the country on Sunday. UN aid chief Mark Lowcock has said if the restrictions remain, Yemen will face “the largest famine the world has seen for many decades, with millions of victims”.

The conflict in Yemen is between Houthis controlling the capital Sana’a, who are allied with former president Ali Abdullah Saleh, and forces loyal to another president, the ousted Abd-Rabbu Mansour Hadi. Since 2015, Saudi Arabia has led a military intervention to counter the advance of the Iran-backed Houthis, with the ultimate aim of reinstating Hadi.

With regional tensions between Iran and Saudi Arabia escalating, Yemen is trapped in the middle of a proxy war in addition to its own internal power struggle. The UK has also been criticised for selling arms to Saudi Arabia despite the high casualty rate of its US-backed airstrikes in Yemen.

In Aden, where Hadi and his government ostensibly rule, parents and children from surrounding governorates crowd the feeding centre in Al-Sadaqa hospital. Aisha was 21 months old but weighed just 7lbs – half the healthy weight of a baby her age – when she arrived at the hospital, her second admission in three months. Across the corridor, two year-old Shohud Hussein, weighing 11lbs, stares vacuously into the middle distance. “Hungry children don’t smile. She’s been here a whole month and hasn’t smiled,” said Dr Aida al-Sadeeq.

In Sana’a, Nor Rashid sold her family’s cow to pay for the transport costs to get her four year-old daughter, who weighs 16lbs, to the city’s feeding centre in Al-Sabaeen hospital. She has other children who are also sick but she cannot afford to pay for the medical care if she brings them in for treatment too. “It’s because of the lack of government wages,” she said. “Usually we go to the person in the village with a wage to ask for help and borrow money if someone needs to go to the hospital. But since the wages stopped we have no support.”

In Al-Thawra, employees grab the sleeve of the hospital’s director, Dr Khaled Suhail, begging him for money as he navigates the teeming therapeutic feeding centre for malnourished children. Government salaries have gone unpaid for more than a year, and the hospital now runs on the goodwill of its doctors, nurses and administrative staff. Suhail clutches the hand of an elderly maintenance man in charge of the hospital’s oxygen tanks as he pleads for cash. “If I had anything to give you, you know I would. But there is nothing,” he says.

Saudi officials have repeatedly claimed that there is no hunger crisis in southern Yemen, where local forces backed by the United Arab Emirates, a coalition partner, largely hold power. According the Famine Early Warning Systems Network, however, Lahij is the most food-insecure governorate in the country. It is ranked at level four, while level five denotes full-blown famine.

In the markets of both Hodeidah and Lahij, food is plentiful. Stalls bulge with fresh fruit and vegetables and traders offer sacks of flour and beans. The only shortage is the customers, who cannot afford to eat. In Hodeidah, the price of a 50kg bag of flour has risen from a pre-war 5,500 Yemeni rial to 7,600 YR. “Fruit and vegetables are a luxury like meat used to be,” said Arafat Zayed, who came to buy three kilos of flour, when he would have bought 50 to feed his family of five children before the war.

In addition to the hunger crisis, Yemen has seen the worst cholera outbreak ever recorded, with more than 900,000 suspected cases and over 2,190 deaths. Although numbers keep rising, in September the rate of infection began to ease, largely due to the response by aid agencies who set up cholera treatment centres in towns and cities around the country.

But the advances could be short-lived if restrictions on aid continue. “If the closure is not stopped in the coming days, we may see that the progress is stopped,” said the World Health Organisation’s spokeswoman in Geneva last week. A Red Cross shipment of chlorine tablets, used for the prevention of cholera, remained stuck for the fifth day on Sunday on the Saudi side of the border with Yemen.

Without the free cholera treatment and essential humanitarian aid, international agencies warn that many more Yemeni children like Abdulaziz will suffer.

“We are weak, our children are weak and we have nothing left to give. We can’t even feed our animals anymore” said Nor Rashid as she cradled her daughter. “Only God can save us now.”

(Photo:  Abdulaziz al-Husseinya, nine years old and suffering from acute malnutrition, Al-Thawra hospital, Hodeidah. Photograph: Iona Craig)