Editor's note: This story was originally published on November 14 and has been updated to reflect a new commentary on Yemen published in The New England Journal of Medicine.
Three weeks ago, 10-year-old Sara was sitting up in her bed at a hospital in Hodeidah, Yemen. A small hole sliced into her throat was helping her breathe.
She was recovering from a rare bacterial infection, called diphtheria. The bacteria had paralyzed part of her body. And there was only one reason why Sara was so sick: Yemen's civil war.
For the past three and a half years, both sides — the Saudi-backed government and Iran-backed rebels — have continually used disease and famine as weapons of war, two doctors write Wednesday in the New England Journal of Medicine.
Health-care providers can no longer stand by silently and let these atrocities occur, Dr. Louise Ivers and Dr. Amir Mohareb of Massachusetts General Hospital write in the commentary.
"The rules of war, which protect health-care facilities, are being broken," Ivers tells NPR. "International conventions guarantee medical organizations can do their work [in war zones]. Violations of those conventions should be a concern to everybody — for everybody's future."
Throughout the civil war, both sides have attacked hospitals, pharmacies, water-treatment plants and sewage systems. During the first seven months of fighting, Doctors Without Borders reported that 39 hospitals were bombed — even though the charity gave the facilities' GPS coordinates to both sides of the war. At the same time, troops have blocked key ports, preventing aid, fuel, drugs and vaccines from entering the country.
As a result, diseases like cholera and diphtheria have cropped up and spread. Medical staff have had to flee. And 14 million people are on the brink of a famine.
In the commentary, Ivers and Mohareb are calling on physicians around the world to advocate for a complete cease-fire and to urge the U.S. to stop supplying Saudi Arabia with weapons and logistically support.
"Health-care workers are in a really unique position to stand up and say, 'We understand what's going on here. We understand that diseases, like diphtheria, don't just emerge from thin air. They are caused by gross negligence of war rules or actual deliberate attempts to interrupt healthcare structures,' " Ivers says. "Doctors have a collective responsibility to take action."
Every 10 minutes a child dies in Yemen, on average, from a preventable disease, the United Nations says. More than 400,000 children are starving. Another 1.5 million are acutely malnourished and need aid to survive.
"Yemen has become a hell on earth for millions of children," says UNICEF's regional director Geert Cappelaere. "Today every single boy, every single girl in Yemen is facing extremely dire needs."
Now Cappelaere — along with leaders of the United Nations and the World Health Organization — fear that lifesaving aid is in jeopardy.
Just days after Cappelaere left the hospital, fighting in Hodeidah became so severe that health workers could no longer access the hospital. Many patients, including Sara, were quickly evacuated.
And this violence is threatening to block food, medicine and other supplies coming into Yemen, warned U.N. Secretary General Antonio Guterres on France Inter radio on Monday.
With a major port on the Red Sea, the city of Hodeidah is a lifeline for humanitarian aid in Yemen. Eighty-five percent of the country's food typically passes through this port, the World Health Organization says.
"If the port at Hodeidah is destroyed, that could create an absolutely catastrophic situation," Guterres says.
It could push 12 million people — the number of Yemenis already close to famine — over the brink, says Suze van Meegen, protection and advocacy adviser in Yemen for the charity Norwegian Refugee Council.
"We would be looking at death on a very, very large scale," van Meegen says.
For this reason, the U.N., UNICEF, WHO and numerous other humanitarian organizations are calling for an immediate cease-fire.
"Not next week. Not in three weeks," van Meegen says. "We need everyone to lay down their weapons and come back to the table to look for a real solution, not a violent one."
The Trump administration echoed that same sentiment two weeks ago. Secretary of State Mike Pompeo wrote in a statement that peace talks must begin this month.
At the same time, though, the U.S. continues to sell billions of dollars in weapons to the Saudis. And until it stopped last week, the U.S. was helping to refuel Saudi planes used in Yemen's war.