Yemen health situation “moving from a crisis to a disaster” UN agencies and non-governmental organisations are warning of a worsening health and humanitarian situation in Yemen as ﬁerce ﬁghting continues. Talha Burki reports.
www.thelancet.com Vol 385 April 25, 2015
virtually all its staple foods. Fuel costs have also spiked, making transporting supplies an even more treacherous proposition. “Health centres are shutting down or working in a suboptimal way”, explains UNICEF’s Fouzia Shafique. “Health workers are concerned about their safety, especially in the south, there is no electricity, and sometimes no water.” The power outages mean that pumps commonly used to draw water do not work, heightening the possibility of water shortages as well as water-borne diseases. Even under more peaceful circumstances, only a third of children with diarrhoeal diseases in Yemen are properly treated. Garbage collections are sporadic and there are reports of corpses littering the streets for days on end, especially in Aden, adding to the likelihood of a disease outbreak.
“...Yemen might lose its entire stock of vaccines.” “Yemen is moving from a crisis to a disaster”, Médecins Sans Frontières’ Sameh Kirollos told The Lancet. “Access to health care has become almost impossible in some parts of the country, due to fighting. Blood banks were already running short before the crisis and have now virtually run dry.” After the air strikes began, health cluster partners were unable to arrange for medical supplies to enter the country. Some shipments have since been allowed through, but the situation remains precarious. It is extremely difficult to bring supplies into the southern governorates, Aden, Lahij, and Abyan, where the ground fighting is fiercest, and into some governorates by road. WHO has warned that if public health facilities are targeted, essential health-care services will be disrupted
and Yemen might lose its entire stock of vaccines. UNICEF has provided fuel for the central cold room and a handful of governorate cold rooms for the next few weeks, but the situation remains precarious. Thus far, the surveillance system is broadly functional, and there are no reports of serious disease outbreaks. “If the conﬂict expands, we would not be able to do the national immunisation campaigns that we used to—we would have to break them down wherever possible”, said Shafique. There are precedents from conﬂicts elsewhere (Afghanistan, for example) for opposing sides to agree upon a temporary ceasefire to allow health interventions to take place, and something similar has been mooted for Yemen. “In places where health facilities have closed, partners in the health cluster are looking at mobile teams to go to those areas once a week to at least make sure children are immunised, childhood illnesses are treated, mothers are given antenatal and postnatal care, and there is some kind of screening and treatment for malnutrition”, adds Shaﬁque. There are also proposals to equip Yemen’s sizeable community of midwives to oﬀer more services at home—even in places where health facilities are functional, women are often reluctant to travel to them, given the possibility of being caught up in the ﬁghting. So it is conceivable that important interventions could continue even if the situation worsens. And with the former president ranged against the current one, a part civil, part proxy war fought on sectarian lines, a strong Al-Qaeda presence, simmering tribal rivalries, and dwindling resources, a worsening situation in Yemen seems sadly inevitable.
Yemen was in serious trouble far before the most recent escalation, when a Saudi-led coalition began attacking the country from the air in late March. Houthi rebels overran the capital Sana’a last September, effectively putting an end to the presidency of Abd Rabbu Mansour Hadi. Since then, the Houthis, who are allied with Hadi’s predecessor Ali Abdullah Saleh and widely thought to have Iranian backing, have pushed south. A ﬁnancial crisis has taken hold, deeply destructive for a country in which more than half the population lives below the poverty line. In January, 2015, UNICEF issued a statement outlining the gravity of the situation: 16 million Yemenis, two-thirds of the population, in need of humanitarian assistance; 13·4 million without access to drinking water; 12 million living without decent sanitation; 8·4 million with no access to health care; 400 000 children in need of psychosocial support; and 75 000 children expected to contract vaccine-preventable diseases. In such circumstances, the long-running malnutrition crisis can hardly be expected to abate. 850 000 children are estimated to be acutely malnourished, around 2 million are chronically malnourished. More than half of Yemen’s children suﬀer stunted growth. On March 25, Hadi ﬂed the country from the southern port city of Aden. It is now a battleground. “The humanitarian situation in Aden is a catastrophe”, said WHO’s Osan Ismail. “Residential areas are witnessing ﬁghting by heavy artillery, in addition to a shortage of fuel, water, electricity, and sanitation.” Food prices in Yemen have reportedly increased by 40% over the past few weeks, and they are expected to continue rising. Yemen imports
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