SANAA, April 6 (Saba) -Since US-backed Saudi-led aggression coalition war on 19 March, Yemen’s already fragile health system has come under enormous strain.
Almost five years of war have devastated Yemen, leaving 18.8 million people in need of humanitarian and protection assistance .
Yemen is facing a growing humanitarian catastrophe as health workers there risk their lives to help civilians caught up in the deadly war.
Heavy bombardment and airstrikes combined with continuous fighting, with few ceasefires allowing for humanitarian activity, have hampered citizens’ access to health care and increased the pressure on the health facilities that are still functioning.
According to the United Nations, more than 1.4 million people have been internally displaced and almost 80% of the population – 21 million since March – requires some form of humanitarian assistance. An estimated 7 million people, almost one third of the population, face hunger.
More than 7 million are facing food insecurity, and more than 8 million face acute shortages of clean water and sanitation. Nearly 3.3 million people – including 2.1 million children – are acutely malnourished including 462 000 children suffering from severe acute malnutrition. Violence since 2015 has forced more than 3 million people from their homes, including 2 million who remain internally displaced as of January 2017.
Years of restricted access and infrastructure damage, as well as attacks against hospitals and other facilities, have left the country’s health system unable to respond to preventable diseases, let alone a pandemic.
"We’re not talking about buying hand sanitizer or disinfectant. People can’t even purchase soap in some places. You have to think about the basic measures people are taking to protect themselves — those might be largely unavailable to people in Yemen."
During the war, the health care system has been strained by preventable diseases, and the breakdown in sanitation led to the largest cholera outbreak in modern history, reaching more than a million cases. Before the war, Yemen was heavily dependent on foreign medical workers -many of whom have returned home — and imported virtually all of its pharmaceuticals and medical equipment.
Import and access restrictions from a Saudi and Emirati naval blockade, fighting, and siege-like conditions across swaths of the country have led to shortages in medicine and equipment. And while comprehensive data on the number of health facilities in Yemen is not public, the U.N. Office of for the Coordination of Humanitarian Affairs has said that only 51 percent of the country’s health centers “remain fully functional.
Recent outbreaks of malaria and dengue were unusually large, health officials say, because tap-water supplies have been disrupted and people are collecting water in containers, creating breeding grounds for mosquitoes. The distribution of mosquito nets and insecticide sprays has been hampered due to the lack of security.
After more than 6000 cases of dengue fever were reported in Aden, Hodeida and other governorates in 2017, the outbreak was brought under control, while a sharp increase in dengue cases was reported in Taiz .
WHO recently launched a nationwide campaign against polio and measles with the United Nations Children’s Fund and the Global Alliance for Vaccines and Immunization. About 4.5 million children under the age of five were immunized against polio and 6 million children under 15 years against measles.
According to UN OCHA 3,2 million women and children in Yemen are acutely malnourished – the number of children suffering from severe acute malnutrition has increased by 90% in the last years.
The health workers in many Yemeni areas are yet to get their salaries, which is made worse by fragmentation in the MoH’s payroll.
Many people suffer from catastrophic health costs to receive the treatment they need in the private sector, even though the quality it provides is substandard.
Recent nutritional surveys have confirmed over 1.7 million children under five and 1.1 million pregnant and lactating women as acutely malnourished. 400,000 children are at risk of immediate death because of the severe form of acute malnutrition. One-third of the 30 million Yemenis are having various degrees of malnutrition.
Yemen’s public sector has been pushed to “a breaking point”, as the country enters its sixth year of war, prompting the closure of half of the country’s health facilities. As of 11 September, 1,095,072 health consultations were provided by the International Organization for Migration (IOM) as part of its emergency lifesaving services and support to the health sector to ensure it continues to operate in the war-battered country.
Over 19,000 people received psychosocial counselling, 113,000 others received reproductive health consultations, and more than 71,000 were part of health awareness-raising activities.
Public health facilities were already strained before the onset of Yemen’s crisis in 2015. Now, people must travel long distances for essential services, while some are forced to go without.
Further, dried up financial resources and a lack of health professionals has catalyzed the problem, while the number of people seeking medical assistance continues to rise in certain areas, overwhelming health centres.
The country’s humanitarian situation remains the worst in the world, according to the UN Population Fund (UNFPA). Around 80 per cent of the population is in need of some kind of assistance.
IOM’s Health Programme Coordinator in Yemen, Dr. Nedal Odeh said that with health needs rising, and many people living in places “with virtually no health services,” the organization's aid to war-affected communities “is vital to the continuation of accessible health services and strengthening of the overall health system in Yemen.”
The majority of the population in Yemen’s rural areas does not have access to formal health services. Many health facilities offer services of very low quality and medical staff do not possess the necessary expertise or management skills to improve the situation. Health education is often insufficient, particularly for women.
The overall deterioration in the country’s social and economic conditions has a serious impact on all public sectors, making Yemen currently the largest humanitarian crisis in the world. Yemen’s gross domestic product contracted by 50%, and the inflation rate went up by 40% just last year.
The oil and gas pipelines have been damaged, and in combination with the blockade of international ports and a reduction in production and export of natural resources, the government’s budget – in deficit since 2015 – was slashed by trillions of Yemeni Riyals.
When you look at it, it’s really a death by a thousand cuts situation,” said Kristine Beckerle, the legal director for accountability and redress at Mwatana for Human Rights. “Yemen’s health sector hasn’t been stretched to its limits; it’s far beyond its limits.”
Of the attacks documented in the report, 35 were aerial assaults by the Saudi and Emirati coalition, and involved bombing raids on 32 separate medical facilitates. “Most airstrikes caused significant damage to the facilities in question, destroying vital medical units and causing widespread disruptions in access and service provision,” the report says.
The Saudi and Emirati coalitionbeen perpetrating violations of international humanitarian law by attacking — repeatedly — the health infrastructure and medical personnel in Yemen.
The 2004 Yemeni constitution states that health is a right for all Yemenis and that the state shall guarantee access to free health care. In the medium term, the vulnerable people of Yemen have to be financially protected against the cost of healthcare.
The report, produced jointly by Physicians for Human Rights and the Yemen-based human rights organization Mwatana for Human Rights, documents five years of attacks against health care facilities in the country, part of a global trend that has led to a record rise in attacks on health care workers and facilities in war zones.
Written by Mona Zaid