TAIZ and ADEN, Yemen — Malia Qassim Mahmoud found herself at Al-Thawra hospital in Taiz, seeking help for the third time for the acute malnutrition affecting her family. Two years ago, her older son was severely malnourished. He recovered but his growth has been stunted; she says the 6-year-old is much smaller than other kids his age.

A year later, she herself had to be hospitalized for malnutrition. Then it was her 1-year-old baby, lying limp in her arms, his skin a sickly yellow color, unable to even open his mouth as his mother tried to feed him protein paste.

"Most days we can only get water and flour and I make a doughy paste and that's what we eat," Mahmoud said. "We can't afford more, and we haven't received any aid through the war."

This family is among at least 20 million people in Yemen who need food assistance in the midst of what the United Nations calls one of the worst humanitarian crises in the world.

In 2014 Houthi rebels backed by Iran overthrew the Saudi-backed government. They took control of parts of Yemen, including the capital city Sana'a and half of Taiz, sparking a civil war. The U.N. estimates that the conflict in Yemen has caused over 377,000 deaths, most of which were due to hunger and lack of health care.

Women and children are particularly vulnerable. According to the World Food Programme, 1.3 million pregnant or nursing women and nearly half of Yemen's children under age 5 — some 2.2 million kids — suffer from acute malnutrition.

Dr. Manal Abdulhaleem, who heads the neonatal department at Al-Sadaqa hospital in the port city of Aden, told NPR they don't have enough equipment or beds to deal with the number of premature babies with anemia and other issues because the mothers are unable to eat enough.

In the intensive care unit for newborns born with complications due to malnutrition, a nurse pulled a sheet over a baby who had just died. The hospital notified his parents, who weren't there.

"We see this a lot," said Abdulraheem. "The family probably used all of their resources to come here in the first place to get treatment but won't be able to afford to come again. Often we have to take care of burials at the hospital without them."

This has been the reality in Yemen for years. Peace talks and diplomatic progress have brought a slowdown in fighting and raised hopes that the war could end. But in the year since the 2022 U.N.-mediated ceasefire, Abdulhaleem said the number of people needing medical attention or hospitalization due to malnutrition has not decreased. Doctors and local aid organizations told NPR that there hasn't been enough international aid coming in.

At a makeshift tent camp for internally displaced people in Aden, people told me they hadn't received humanitarian aid in over a year — except once during Ramadan in April 2023. Many of the men try to find work, but in a devastated economy, many families can only afford to eat once a day. I spoke to several families who said their children often go to bed hungry.

"The humanitarian situation is really pretty serious throughout the country with over 20 million people in need, of which we are probably providing food to about 10 1/2 million people," said David Gressly, the United Nations resident and humanitarian coordinator for Yemen, who is based in Sana'a.

"We're currently funded at 29% of our requirements for the year. We had put forward a requirement of $4.3 billion," Gressly said. "That's already a fundamental limit on how much assistance can be provided."

The United States and European countries have been contributing as usual, according to Gressly. But there has been a drop in donations from the two Persian Gulf countries that have been most directly involved in the conflict – Saudi Arabia and the United Arab Emirates.

"For example, the UAE is not in a position right now to contribute, even though they did two years ago," Gressly said. "And the contributions coming from Saudi Arabia are also quite a bit lower than in the past. That's where our core problem is right now in terms of funding."

NPR requested comment from the foreign ministries of Saudi Arabia and the United Arab Emirates. There was no response from Saudi Arabia.

We received the following statement from a UAE official.

"The UAE remains committed to providing critical humanitarian aid and development assistance to the people of Yemen through close collaboration with the United Nations. The guiding principles of UAE Aid include maximizing impact and ensuring efficiency for its donor funds, to this end, in Yemen, the UAE is providing assistance through organizations, such as the Emirates Red Crescent and Khalifa bin Zayed Al Nahyan Foundation."

In August, Saudi Arabia pledged a package of $1.2 billion that included food aid to the government of Yemen, which has limited ability to distribute the food or provide other basic services.

While the shortage in aid is one major driver of the humanitarian crisis, another is the unresolved conflict. Yemen remains divided between Houthi-occupied and Saudi coalition-held territory, with fuel shortages and access to essentials like water, food and medicine restricted in many areas.

This is especially acute in Taiz, the third largest city in Yemen,which has been on the front lines throughout the war. The city is cut in half, with Houthi forces on one side and government-controlled areas on the other. Taiz is riddled with landmines. Even the water has been weaponized during the conflict, with most of the water basins located on the Houthi side and most of the city's population densely packed on the government side.

Dr. Abdulqawi Dirham, head of the nutrition department at Al-Thawra hospital, said most of the people with acute malnutrition in Taiz and nearby areas can't even access treatment due to roadblocks and lack of transportation.

And he said they have another serious problem: The hospital isn't clean. They don't have enough sanitation supplies, and there has been no functioning ministry of health to oversee things. Many patients have picked up infections at the hospital.

"Now, we don't keep anyone longer than a week [to reduce their risk of hospital-acquired infection], which is often not enough time to recover from malnutrition," Dirham said.

"One of my major concerns is places like Taiz that have not seen the kind of benefit that the de facto truce has provided to other populations in the country," said the U.N.'s David Gressly. "I'm concerned about that from a larger point of view, because we want everybody to have a stake in peace and to believe that peace will be of benefit to them."

Malia Qassim Mahmoud, the 27-year-old mother who has seen repeated instances of malnutrition in her family, said she was hopeful that her 1-year-old son would recover soon. But once they go back home, nothing will have changed. She will still only be able to feed her family with flour and water. And as long as Yemen remains in desperate need of aid, Mahmoud said it's likely that she and her family would end up at the hospital again.