Aid groups are warning that the war in the Middle East has upended their ability to get food and medicine to millions in need and that more people will suffer if the violence continues.

Humanitarian experts say there’s been a slower international response to fund aid during this war compared to previous conflicts like Ukraine, which could reflect growing pressure to invest in security over aid at a time when the world is in turmoil.

“They’re making hard choices between defense security and humanitarian aid,” said Sam Vigersky, an international affairs fellow at the Council on Foreign Relations who has written about the war’s impact on aid.

He said when the U.S. goes to war, it normally has provisions for aid, but hasn’t been “activating” those provisions. “It’s not a capacity issue, it’s a policy decision,” he said.