Yemen is home to the worst humanitarian crisis in the world for the second year running, according to new analysis by the International Rescue Committee (IRC). 

The country has been embroiled in a brutal civil war since 2015 that has resulted in 100,000 casualties, 3.65 million displaced persons, a massive cholera outbreak, and widespread hunger. Constant aerial bombings by a Saudi Arabia-led campaign has devastated the country’s infrastructure, from hospitals to schools to water pipes. 

More than 24 million Yemenis are in need of humanitarian assistance, the IRC reported in its annual report. 

“The situation here in Yemen continues to get worse with no end in sight,” Frank Mc Manus, IRC’s Yemen country director, said in a press release. “The people of Yemen need humanitarian relief now. Current humanitarian access is neither efficient nor effective.” 

The annual IRC Watchlist ranks the 10 worst humanitarian crises in the world as a way to focus aid efforts. 

This year’s list highlights the protracted nature of humanitarian disasters. 

“There has been little change in the countries that have been ranked highest in terms of humanitarian need compared to last year,” said Bob Kitchen, the IRC’s vice president for emergencies, in a statement accompanying the report. “This is evidence of the drawn-out nature of many of these crises and underscores the importance of coming together to urgently resolve the root causes of humanitarian crisis.” 

The Democratic Republic of Congo, which has 15.9 million people in need of humanitarian aid and is currently experiencing an ebola outbreak, is ranked second on the Watchlist.

The Syrian civil war continues to churn in all of its horror, earning the country the third spot on the list. The country has generated the largest outflow of refugees over the past decade and today leaves more than 11 million Syrians in need of humanitarian aid. 

Nigeria, home to the largest population of people living in extreme poverty, was listed in fourth place for the many conflicts that continue to displace and destroy communities.

The fifth-worst crisis is taking place in Venezuela, where a severe economic crisis has made it hard for people to get food, water, health care, education, and more. 

Afghanistan, South Sudan, Burkina Faso, Somalia, and the Central African Republic round out the list. The full Watchlist includes 20 countries, home to 10% of the world’s population, but 80% of the people in need of humanitarian aid. 

“Across the globe, the scale of need in 2020 is also likely to stretch resources beyond their limit,” David Milliband, head of the IRC, said in a statement. “It’s vital that we do not abandon these countries when they need us most, and that governments around the world step up funding to these anticipated crises before more lives are lost — and the bill for humanitarian catastrophe rises.”