CAIRO — After five days of treatment in a shabby Yemeni hospital, Luai Sabri died on Tuesday. The 20-year-old had a cracked skull, a...

CAIRO — After five days of treatment in a shabby Yemeni hospital, Luai Sabri died on Tuesday. The 20-year-old had a cracked skull, a ruptured spleen and a damaged liver, according to a relative, injuries caused by a bomb that dropped from a warplane flown by the Saudi-led coalition.

The airstrike was part of a wave of bombings over the Yemeni capital, Sana, last Thursday that coincided with a spike in tensions between the United States — which supports the Saudi-led coalition in Yemen — and Iran — which backs the coalition’s enemies, the Houthi rebels.

Several airstrikes hit Houthi targets on the city outskirts. But one pulverized several homes in a crowded residential area where Mr. Luai, a recent high school graduate, lived.

Five people died immediately — his brother Hassan, 17, and four children in a house next door, the youngest of whom was 6. Among the 31 people wounded in the attack were Mr. Luai’s father, a former Houthi official, his grandparents and another 15 children, according to relatives and the Yemeni human rights group Mwatana.

They were the latest casualties of an air war that has killed thousands of Yemeni civilians since 2015, stirring outrage against a Saudi-led coalition, which had already been criticized for limiting food shipments to the famine-threatened country.

The civilian toll has fallen considerably this year as a truce brokered by the United Nations in the key Red Sea port of Hudaydah, previously a major focus of the conflict, has held steady. But indiscriminate attacks, like last week’s strike in Sana, continue.

The civilian carnage remains an American liability, too.

Gen. Joseph F. Dunford Jr., the chairman of the Joint Chiefs of Staff, told Congress in April 2018 that the United States, although a close ally of the coalition, is not involved in the “kill chain” in Yemen.

The war’s many critics, in Congress as well as in the human rights community, call that a gross understatement. While Saudi or Emirati pilots usually pull the trigger in raids on Yemen, the United States provides the warplanes, munitions and intelligence used in many of those strikes.

The ethical quagmire evolved into a political storm this year when Congress passed a bipartisan resolution withdrawing American support for the war, only to be blocked by President Trump who used his veto last month. The measure was “an unnecessary, dangerous attempt to weaken my constitutional authorities,” endangering the lives of American citizens and service members, Mr. Trump said.

Defending their role, American generals describe a lack of training and education among their Arab allies, and point to a series of measures they have imposed on the coalition to reduce civilian casualties since the air war started in 2015.

The Americans helped set up an internal investigations body, helped draw up a lengthy no-strike list of hospitals, schools and other targets to be avoided, and provided coalition pilots and their commanders with training in human rights and the laws of war.

An airstrike in Sana last week in a residential district.CreditMohammed Huwais/Agence France-Presse — Getty Images

A small team of American military advisers has been posted to the coalition air command center in Riyadh since at least 2016. Yet civilian deaths continue.

The Saudi-led coalition is responsible for 4,800 of about 7,000 civilian deaths caused by direct military targeting in the war since 2016, according to the Armed Conflict Location & Event Data Project, which monitors the toll. (The group’s data excludes 2015, when the war started).

The Houthis were responsible for 1,300 civilian fatalities from direct targeting in the same period.

Like the coalition, the Houthi rebels also face accusations of manipulating urgently needed relief aid. This week the World Food Program threatened to cut aid to Houthi-controlled areas where it accuses officials of blocking aid convoys and interfering with food distributions.

As American military aid to the coalition continues, a former American official in Yemen says the carnage highlights the need for a major overhaul in the way the United States provides military assistance in Yemen and other conflict zones around the world.

Larry Lewis, who worked as a State Department adviser on civilian harm with the Saudi-led coalition from 2015 to 2017, said that while the number of civilian casualties in Yemen has fallen since 2016, the rate of civilian deaths has risen from about 8 percent of all incidents to about 15 percent.

In a new report for the Center for Naval Analyses, Mr. Lewis says that the United States must intensify training programs for military partners as a condition of military aid. Civilian deaths should be closely monitored and, if they reach unacceptable levels, should result in a suspension or cutting of military aid.

Others, though, say that the United States has tried improving Saudi behavior for long enough, and that now it is time for tougher action.

“Stronger levers to hold the coalition accountable are a fantastic idea,” said Kristine Beckerle of Mwatana, which has called on the United States to cut its support to the Saudi-led coalition. “But if your partner appears consistently unwilling to comply with international law, or to minimize harm to civilian life, then at some point you should not be partnering with them at all, as is clearly the case for Yemen.”

Andrew Miller, a former State Department official now working with the Project on Middle East Democracy, a nonpartisan group, said that American officials intent on countering Iranian influence in the Arabian Peninsula presume that continued military assistance to Saudi Arabia and its allies is necessary.

“We need them, we don’t have any alternatives, and so we need to make the best of a bad lot,” Mr. Miller said, explaining the mind-set.

While stronger controls for military assistance programs are welcome, he added, skepticism about the coalition’s willingness to change is warranted by its record of civilian casualties.

“Either they are less concerned about civilian casualties or they see some utility in killing civilians as a form of collective punishment,” Mr. Miller said. I have no evidence to support either case. But it would not be the first time in the Middle East that we see such tactics.”

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