“It seems we ran away from death just to die slowly here,” said Rasha Abdullah, a 27-year-old from the embattled Yemeni port town of Aden, cradling her barefoot daughter, Nourhan, 2. “In Aden at least we only died once. Here we die 100 times.”

These are the Middle East’s newest refugees — thousands of civilians fleeing the civil war that has engulfed Yemen, just a few miles across the Gulf of Aden from Djibouti, a strategically situated but impoverished African nation that houses a major U.S. military base. The war in nearby Yemen has reverberated profoundly in Djibouti.

Besides hosting a new flow of refugees, who mostly arrive via boats across the Gulf of Aden, Djibouti has also become a logistic hub for a massive relief effort to Yemen during the five-day cease-fire, which ended Sunday, bringing renewed bombardment – and probably more refugees.

During the truce, international aid agencies working out of Djibouti have shipped thousands of tons of foodstuffs, fuel, medicines, sleeping mats and other essentials to Yemen by boat and plane. United Nations officials and aid groups have called for an extension of the cease-fire and the opening of peace talks between the warring factions.

The recent fighting in Yemen has forced almost half a million Yemenis to flee their homes, according to the United Nations. Most have remained inside the country, internally displaced, often trapped. About 30,000 people -- Yemenis and foreign nationals, including U.S. citizens -- have left Yemen since a Saudi-led bombing campaign against rebels challenging the Yemeni government began in March, the U.N. says.

But officials fear the relative trickle of Yemenis escaping the country could become a torrent should the fighting continue in earnest after the oft-broken truce.

Until the cease-fire, boatloads of refugees regularly embarked from Aden, a scene of fierce battles between Houthi rebels based in the north and various southern militias. Refugees said they huddled in the port area of Aden waiting for days for boats out, often as gun battles raged. Vessel skippers charged exorbitant rates of $200 or more for the trip across the gulf to Djibouti, they said. The journey can be hazardous.

Early this month, as many as 40 Yemeni civilians seeking to escape Aden by sea were reported killed when shells hit their boat. Who fired remained unclear.

Among exiled Yemenis interviewed in Djibouti, there appears to be little hope that the conflict in their homeland will end any time soon. A sense of deep despair emerges.

A good number of those who escaped here hail from Aden, where many residents support a southern separatist movement and are hostile to both the Houthi rebels who control Sana, the capital, and to the exiled government of President Abdu Rabu Mansour Hadi. The president is from Aden but has not backed the separatist cause and is not especially popular in his hometown. The allegiances of refugees here highlight how the Yemeni war is a complex, multifaceted conflict with many sides and shifting loyalties.

“Independence for the South!” chanted Mazen Rubaty, a Yemeni refugee, to a group of foreign journalists who arrived at the isolated Markazi refugee camp, set up for those fleeing Yemen.

The camp, a sprawling expanse of canvas tents provided by the United Nations, is outside of the port town of Obock, an almost four-hour drive north of Djibouti city through a barren landscape of volcanic rocks and stunted shrubs marked by occasional goat-herder shanties and camels. It is home to about 500 Yemenis, the U.N. said, but the number is expected to rise. Most Yemenis who have come to Djibouti rent apartments and hotel rooms or stay with friends or relatives.

Rubaty, 38, a father of four, was recuperating from a bullet wound in the back received in Aden, where battles raged before the cease-fire was called last week. A gauze bandage was wrapped around his lower back and abdomen.

“I was just walking down the street when I was shot,” said Rubaty, a grizzled former merchant seaman. “For me, Yemen is finished. I will go back when the south is free.”

U.N. officials say they are doing what they can to make the camp livable. But conditions remain primitive in what is still a new facility. There is only one generator and limited shade. Doctors identified six cases of acute malnutrition and 12 cases of moderate malnutrition among Yemeni refugee children under 5 years old, the U.N. said.

“We are trying to do everything possible to meet the people’s needs in a very challenging and remote environment,” said Marie-Claire Sowinetz, an official in Djibouti with the U.N. refugee agency.

Many of the Yemenis who fled here left relatively stable, middle-class lives. A few weeks ago, they were living in air-conditioned homes and apartments in Aden, an animated former English colonial outpost that used to bustle with street life, cafes and restaurants. The war made it perilous to leave the house, refugees said, and the shelling and bombardment meant being inside wasn't necessarily safe either.

“We went from a normal life to gun battles in the streets,” said Mohammed Qaity, 45, who escaped with his wife and two children on a boat from Aden.

He and other men were found on a recent afternoon under the shade provided by the roof of a mosque. Others stayed inside their tents to escape the punishing sun.

Among those stuck here was Abdullah Nasser, a British citizen, son of a Yemeni immigrant to Britain and an English-Irish mother. He has a British passport and could have gone to England, but he said authorities would not allow his Yemeni wife to accompany him because she does not have British citizenship.

“I was basically asked to choose between my family and myself,” said Abdullah, speaking soft English with the accent of his native Yorkshire. “I could not abandon my wife and my family. So we are all stuck here now. We have no idea what is next.”

Many are worried about the upcoming season of Ramadan, the daily fasting period that begins in June, when daily temperatures will likely exceed 100 degrees. They will be hungry and hot with little to do.

“When Ramadan comes it will be very bad,” said Rasha Abdullah, the 27-year-old from Aden who, like many others, said she hoped to be resettled in Europe. “We want to go to some cold place — not to any Arab nation. The Arabs have treated us very badly.”