From smouldering bomb-sites in the pockmarked cities of Sanaa and Hodeidah to children lying on stained mattresses on hospital floors, waiting — perhaps in vain — for the anti-cholera drugs they need to fight a killer infection.

Starker still are the photos of emaciated Yemenis, their ribs and arm bones poking through stretched skin, testament to the famine-like conditions that have ravaged a country that sank into chaos after a political crisis in 2011.

But beyond these images and the headline death toll numbers – estimated to be in the region of tens of thousands of people – question marks still remain over how much devastation this war has wrought on Yemen’s 30 million people.

Should it be counted in dollars? Or the number of lives lost? And, should the death toll include those who have perished from hunger and disease as well as those who have died from bullet wounds and bomb blasts?

Researchers from Denver University tried to answer those questions this week, with the release of a report under the auspices of the United Nations that seeks to calculate how much the war has derailed progress in Yemen.

The numbers do not look good, said UN spokesman Stephane Dujarric. “The ongoing conflict in Yemen has already reversed human development by 21 years,” said Dujarric.

Should the war end this year, it will have cost Yemen’s economy $89bn and claimed the lives of 233,000 people, researchers told Gli Occhi della Guerra.

That number is far higher than other counts. It includes not only 102,000 combat deaths, but another 131,000 fatalities from side-effects, such as hunger and the fact that many hospitals have been shelled to rubble.

Researchers also pushed the clock forward, calculating Yemen’s losses were the war to drag out until 2022 and even 2030 — a ghastly but not impossible scenario given the current slow pace of peace talks.

“The study warns of exponentially growing impact of conflict on human development. It projects that if the war ends in 2022, development gains will have been set back by 26 years — that’s almost a generation,” said Dujarric.

The 68-page study, commissioned by the UN Development Program, found that a war dragging out until 2030 would leave 84 percent of Yemenis malnourished and 71 percent of them living in extreme poverty.

By then, the country would have lost $657bn, a figure that is 18 times the size of Yemen’s economy before fighting ramped up in 2015, when a Saudi Arabia-led coalition joined what had hitherto been a largely domestic conflict.

By 2030, the death toll would have climbed to 1.8m, the vast majority of them victims of poverty and a war-ravaged healthcare system. Most of the dead — 1.5m — would be children, who are more vulnerable to sickness and hunger.

Researchers call it among the “most destructive conflicts since the end of the Cold War”. “The scale of suffering borne by the children of Yemen is devastating. The international community must come together to ensure peaceful resolution to the conflict in Yemen and promote a path towards recovery,” they said.

Riyadh is leading a Western-backed Sunni Muslim military coalition that intervened in Yemen in 2015 to restore the internationally recognized government of President Abd-Rabbu Mansour Hadi, which was ousted from power in the capital Sanaa by Iran-backed Houthi rebels in 2014.

The warring parties reached a deal at UN-sponsored talks in Sweden in December for a ceasefire and troop withdrawal from the Red Sea port city of Hodeidah, a lifeline for aid and other supplies to millions of Yemenis.

The truce has largely held but the redeployment of forces has stalled with each side blaming the other for derailing the deal, the first major breakthrough in peace efforts in more than four years aimed at paving the way for political negotiations.

The conflict, which has pushed poorest nation on the Arabian Peninsula to the brink of famine, is largely seen in the region as a proxy war between Saudi Arabia and its arch foe across the Gulf, Shiite Muslim Iran.

Researchers urged all sides to stop playing politics and demanded a “push towards a sustainable peace deal and a stop to further escalation”.

“The situation is already extremely severe. If it deteriorates further it will add significantly to prolonged human suffering, retard human development in Yemen, and could further deteriorate regional stability,” the report says.

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