in Yemen, on a busy hospital in a small city called Abs.

Nineteen people were killed and dozens were injured.

The pilot missed clear warning signs

and ignored safety measures, like a no-strike list

of protected buildings.

Found in the debris, the remains of a U.S.-made weapon.

America isn’t officially involved here.

The fight is between a Saudi-led coalition

and the Houthi rebel group.

But it’s very much a U.S.-supported war.

The fighter jets, the bombs, the training

and intelligence — much of it is supplied to the Saudis

by the U.S.

It’s a brutal war.

The Houthis have killed hundreds of Yemenis.

The Saudi air campaign has been even more lethal.

Over four years, coalition airstrikes have killed

thousands of civilians and bombed well over 100 medical

facilities, a Times assessment found.

“If U.S. fighter pilots were doing this directly

with U.S. bombs, would there be a change in behavior?”

“If we were hitting hospitals, over and over,

like what we’re seeing?

Absolutely, there would be a change.”

Which begs the question: What obligation

does the U.S. have when it sells weapons

to foreign militaries?

U.S. officials claim their ally is doing everything

possible to protect civilians.

But this is simply not true,

according to Larry Lewis, a former State Department

official, who saw firsthand how the Saudi coalition failed

to protect civilians and how the U.S. chose

to look the other way.

“Yemen has exposed a fundamental problem

in the way we provide arms and the way we support partners.

So we need to change the way we do business.”

Lewis spent years working with the U.S. military

in Iraq and Afghanistan to try to reduce

civilian casualties.

He wrote a book on protecting civilians

that’s issued to every U.S. soldier in Afghanistan.

And in 2015, the Obama administration

sent him to work with the Saudi coalition in Riyadh.

“There were some fundamental problems

with how some of the targeting was being done that really

needed to be fixed.”

During his time there, he reviewed the Abs hospital strike

with an investigations team

he helped the Saudi coalition to create.

“What did you learn from reviewing that airstrike

with the Saudis?”

“You look at the level of destruction

in the nearby buildings and go, the pilot

got it way wrong.”

Let’s take a look at what happened there.

Coalition warplanes attacked a Houthi checkpoint

a few miles north of Abs.

Medics say that a car transported casualties

to the Abs hospital from the strike.

The Saudi coalition tracked the car,

believing a Houthi leader was inside.

For some reason, they didn’t strike it on the open road.

Instead, they waited until the car pulled into the hospital.

It parked by the emergency room

and was hit without warning.

Three major failings were evident in the Abs strike,

Lewis says, and these were repeated

throughout the Saudi-led air campaign.

“Doctors Without Borders say that they

provided the hospital coordinates

to the Saudi coalition.”

“That’s right.”

“So why did they still hit it?”

“That information didn’t get to the cockpit.”

The Saudi coalition is often praised by the U.S.

for creating a no-strike list, a map of protected sites

like schools, refugee camps and hospitals.

The list is used to vet targets

when airstrikes are preplanned.

But that doesn’t happen for the vast majority of strikes,

which are on-the-fly bombings or so-called dynamic strikes.

“What can be done to limit the number of dynamic strikes,

or at least force them to check the no-strike list?”

“Mhm.

This is not rocket science.

It’s not hard to make a requirement for pilots

to call back to higher headquarters

and say, check the no-strike list

and tell me if this object is on the no-strike list,

or if there’s something that’s close by.

It would take a minute or two.”

Another problem?

Over and over, Lewis says, pilots

seem to ignore large roof signs that

identified hospitals, including the one in Abs.

We can see six of them in this satellite image

taken before the strike.

“So the pilot could have seen this marking and recognized,

hey, this is a protected facility.”

On top of all this, a major issue

is a lack of common sense among pilots and spotters

on the ground.

“You have a pilot that’s not really so experienced,

and then you have a person, who’s

not even a military person,

agreeing on what they think is a valid target,

and then engaging that target.

So, it’s really fraught with peril.”

In Abs, a teacher named Hamza Ahmed Absi

saw that peril firsthand.

He rushed to the hospital from a nearby school.

Muhammad Darm was badly injured in the attack.

He’s an X-ray technician, who was helping

patients near the hospital’s entrance

when the bomb exploded.

Muhammad was lucky to survive.

He recently returned to work in the hospital.

Once a sanctuary in a time of war,

he says it no longer feels safe.

For years, officials in both the Obama and Trump administrations

have said they’re

working directly with the Saudis

to stem civilian casualties.

“I think every Yemeni that is killed —

any innocent person is killed —

it affects all of us.

And there are many steps that are being taken,

and have been taken, to try to minimize that.”

“The training that we have given them, we know

has paid off.”

“We are co-located with them in their operation centers

to help them develop the techniques and tactics that

will allow them to conduct strikes while mitigating

civilian casualties.”

But one problem with U.S. oversight,

Lewis says: The U.S. wasn’t tracking

how the American weapons it sold

were being used by a Saudi military

with little experience in war.

In 2018, three years into the conflict, the head of

U.S. Central Command said as much.

“Is CENTCOM able to tell whether U.S. fuel or

U.S. munitions were used as part of that strike?”

“Senator, I don’t believe we are.”

Lewis says they did have access to that information.

They just weren’t using it.

“Every flight by the Saudi-led coalition

where they were doing airstrikes, that pilot would

then make a report that talked about what target was it,

what kind of weapons did they use

and just information about the strike.

They would file it and then that

would go to populate this Excel spreadsheet that

had every single strike in the campaign.”

“And the U.S. and U.K. had access to that database?

“They did.”

“So if the U.S. wanted to know if American bombs were bombing

hospitals, they could have done so?”

“Yes.”

A year later, after reporters disclosed the database,

General Votel changed his tune.

“Today, we do have that.

We do have a database that does have that information

and we have the ability to see that.”

Lewis says the database could be a tool

to increase U.S. oversight in reviewing foreign weapons sales.

A State Department official told us this kind of data

could be incorporated into its monitoring, but vetting it

can be onerous, and it may be of little use

to policymakers.

After a Saudi coalition airstrike

on a funeral home killed over 150 people in late 2016,

the Obama administration, having brokered $100 billion

in weapons sales, now sought to distance the U.S.

from the coalition.

“And their response was, clearly, the Saudis

aren’t learning.”

It paused sales of precision weapons,

and pulled the plug on Lewis’s advising mission.

“The U.S. said this is up to the Saudis to do their thing

and investigate themselves.”

When President Trump took office,

the U.S. doubled down on weapons sales.

“So we make the best equipment in the world.

There’s nobody even close.

And Saudi Arabia’s buying a lot of this equipment.”

In Yemen, things for civilians continue to get worse.

In 2018, the rate of civilian casualties

caused by the Saudi-led coalition soared, Lewis says,

to almost 50 per week.

And in Abs, history repeated itself.

Yet another medical facility was attacked

in June of that year.

The airstrike destroyed a vital cholera treatment center

built by Doctors Without Borders

to handle the worst outbreak of the disease

in modern history.

The Saudi coalition tried to shift blame to

Doctors Without Borders, saying its buildings

weren’t marked.

But again, satellite images from before the strike

show large red crescents were visible, even from space.

And Doctors Without Borders say

they shared the center’s coordinates at least 12 times.

The Saudis deny this.

The U.S. sells weapons to over 100 countries,

but in Yemen, the scale of the devastation

has become the story.

And for the people living there, it’s the new normal.