By last December, the main hospital in the city of Hajjah in northern Yemen had already received 200 suspected cases of cholera. The patients were being treated at a month-old cholera center supported by the World Health Organization.
Across the country, U.N. workers had recorded 122 confirmed cases by then, including 10 confirmed deaths and 72 suspected deaths.
Today, the number of suspected cholera cases in Yemen has reached half a million and nearly 2,000 people have died, the WHO recently reported. It is now the largest cholera epidemic in the world.
Only a few years ago, the waterborne disease had been nearly eradicated in Yemen.
When I visited the Hajjah hospital, it was hard to imagine another instigator tormenting the poorest nation in the Middle East. War-ravaged Yemen was reeling from a severe hunger crisis and worsening poverty. Parents were being forced to choose between taking their sick children to the hospital and feeding their healthy ones.
The hospital itself was in shambles. Ventilation machines and other essential equipment were broken. The staff had not been paid in four months. The facility owed $55,000 to the water department in unpaid bills.
If it wasn't for international funds, the hospital would have never opened the cholera center. Still, when I was last there, the disease seemed to be the least of Yemen's many woes.
The outbreak started to spread fast at the end of April, propelled by poor sanitation and limited access to clean water for millions of Yemenis. And although its spread has slowed in some areas, it is speeding up in other zones, infecting an estimated 5,000 people per day, the WHO said.
All this as the health system has further crumbled. Airstrikes from a Saudi-led coalition fighting Houthi rebels have destroyed or damaged more than half of Yemen's heath facilities. A lack of funds has forced others to close.
Shortages of medicine and supplies have grown dire, largely because of a Saudi-imposed economic blockade and bureaucratic delays by Houthi officials. The hunger crisis is propelling the country toward famine, leaving even more of the population vulnerable to diseases such as cholera.
About 30,000 government health employees vital to fighting the epidemic have not been paid in nearly a year, according to the WHO.
"These doctors and nurses are the backbone of the health response - without them we can do nothing in Yemen," Tedros Adhanom Ghebreyesus, the director general of the WHO, said in a statement. "They must be paid their wages so that they can continue to save lives."
The re-emergence of cholera is the latest fallout from a crushing war driven by regional and sectarian rivalries, and backed by Western powers. Saudi Arabia and its neighbors are seeking to restore Yemeni President Abed Rabbo Mansour Hadi, who was ousted by the Houthis in early 2015. The region's Sunni rulers are wary of the Shiite Houthis, who are widely believed to be backed by Iran, Saudi Arabia's main rival.
The Saudi-led coalition has largely used U.S. and British weapons that have killed thousands of Yemeni civilians. The United Nations estimates that more than 10,000 have died and 3 million have been driven from their homes.
"This is no accidental disaster - it is a man-made disaster driven by national and international politics," Katy Wright, the head of advocacy for Oxfam said last week in a statement, referring to the cholera crisis. "In backing this war with billions of dollars of arms sales and military support the U.S. and the U.K. are complicit in the suffering of millions of people in Yemen."
An Oxfam study released last week found that many Yemenis are now being forced to make a stark choice: treating cholera-infected family members or putting food on the table.
"The current rainy season is likely to aggravate the spread of cholera and other diseases can easily break out, as a recent increase in meningitis cases shows," the report said. "And all efforts to contain the multitude of crises have failed so far."