Anisa is only 18, but already a mother of two and a widow. She married her husband, a fisherman, at 13. He “fell in the sea”, she says, and never came back. Cradled in her lap, Anisa’s younger daughter Amina is just shy of her third birthday. She looks more like a baby than a toddler. A fine layer of sweat covers her oversized forehead. She breathes rapidly, her belly sticking out from a dirty T-shirt, distended by hunger. Like many poor rural Yemenis, Anisa and Amina have suffered a series of shocks from which they may not recover.

Even before 2011, when an uprising unseated Ali Abdullah Saleh, Yemen’s ruler of 33 years, and fighting between military and tribal factions threatened to tear the country apart, life was hard for Yemen’s poor. Rabbat, Anisa’s village, is an inland hamlet of the coastal province of Hodeida where farming has been hit by years of drought and rising fuel prices. Young men travel far in search of dangerous, low-paid work on fishing boats or try their hand at smuggling to Saudi Arabia.

Life was just bearable before the political crisis. Anisa’s father, a barber, gave what he could. Neighbors helped with food and money. This community spirit has long cushioned suffering in a country aid workers have described as “on the brink” for decades.

Everything in Yemen travels by road, and most water is drawn from the ground using diesel-powered pumps. During the unrest both roads and fuel supplies were often cut, so prices for basic goods rose fast. Many businesses closed, and farms suffered another year with little rain. Unemployment rose above 50 percent. In late 2011, the government decided to cut fuel subsidies.

As household budgets have shrunk, better-off Yemenis have had less to give their poorer neighbors. Many have taken to buying food and water on credit. Anisa has no way of paying off the YR 20,000 (USD 90) she owes for water, and worries about getting more. She and her daughters now eat twice a day when others can spare food or money: tea, bread, rice, maybe some fish if they are lucky.

In March, the UN’s World Food Programme (WFP) reported that levels of food insecurity in Yemen had doubled since 2009. Today 5 million people go hungry so often that it affects their long-term health. According to UNICEF, the WFP’s counterpart for children, some 30 percent of kids in Hodeida are “acutely” malnourished, threatened with stunted growth and cognitive impairment. The 30 percent figure is twice the level the UN uses as a benchmark for crisis. And hunger is rising, says Lydia Tinka, a veteran of multiple African crises who works in Hodeida for Oxfam, a British charity.

The big aid agencies are gearing up for an appeal, but fear it will be hard to raise money until there is evidence that people are starving to death. Yemenis like to keep things behind closed doors; failure to care for children is seen as shameful and meetings with people like Anisa remain a rarity. Until poorer Yemenis open up or start dying, their plight risks being ignored.