YEMEN: “Some pregnant women & sick children arrive so late to the hospital that we can’t save their lives”

Monday, October 22, 2018 — Gisela Vallès is medical team leader at the Doctors Without Borders (MSF) hospital in Abs, the capital of the district of the same name in northern Yemen. Increased fighting in the region in recent weeks is causing new waves of displacement. Gisela explains the challenges and obstacles her team face in providing assistance to the displaced groups and host communities.

How does the conflict affect people in the district of Abs?

The MSF hospital in Abs is currently receiving war wounded every day. Between August and September we treated 362 injured people, more than 40 percent of all the wounded we treated in 2018 at this facility. Many are civilians who are caught in the crossfire of airstrikes and missiles. The intensification of the fighting about 50 kilometres north of Abs, in the area of Beni Hassan, close to the border with Saudi Arabia, has caused a massive new wave of displacement. Since August, about 20,000 people have relocated to other parts of the region, joining several thousand others who fled earlier fighting. It is difficult to trace them because there are no formal camps for internally displaced people (IDPs). They are scattered across a very large area. Sometimes there are groups of IDPs living under basic plastic sheets that they buy or that are donated to them. Other times they are mixed with local communities. In any case, they all live in very precarious conditions.

Do they have access to health services?

The majority do not have access to health services because, after several years of conflict, there are few health centres open in Abs district. Many health centres are no longer functional or are open for only a few hours a day with just a nurse or a small staff. Those working in the health centres have not received salaries for more than two years and work without adequate medical supplies. The health system can’t respond to the needs of the IDPs and, at the same time, we are severely restricted in the assistance we can offer in the places that are absorbing new displaced communities. In September, our mobile team was only able to go out to the periphery of Abs seven times during the month, despite being prepared to leave every day. In addition to this, in recent weeks the Yemeni currency, the Ryial, has lost a lot of value, while inflation has risen, causing fuel and transportation costs to increase. This had made it unaffordable for many people to reach the hospital in Abs. It is important that the few medical organisations that are supporting the Ministry of Health on the ground gain more access to address the needs of vulnerable displaced communities.

What are the consequences of this situation?

One consequence that strikes me is seeing many patients arrive too late to the hospital. Some pregnant women and sick children arrive so late to the hospital that we can’t save their lives. Virtually none of the women here receive antenatal care because this service is non-existent or ineffective outside of Abs town. They arrive with conditions that could be prevented, such as eclampsia and pre-eclampsia, which can both be fatal to the mother. By providing proper antenatal care and ensuring a safe birth we could reduce the risk of complications for both mothers and newborns.

How do our teams work to try to arrive on time?

In areas where the security situation and the authorities allow, we have a network of community health workers that manage a referral system for the most severe cases. Currently we focus on area with new IDP settlements where the most basic services are missing. In September, 153 patients from other parts of the region were referred to the Abs hospital, 50 percent more than in August, while in July the situation was more stable. The forecast is that in the near future there will be many more patients referred, as the hostilities intensify.

Can the situation get worse?

The worsening fighting [which escalated in March 2015] is undermining the capacity of NGOs on the ground to provide relief, water and sanitation services, food and more. The high inflation, linked to the rapid devaluation of the Ryial, the import restrictions etc. can have an impact on the nutritional status of the population. We continue to receive many cases of easily preventable diseases, such as diphtheria. This shows that the impact of the war on the deteriorating health system is increasingly affecting vaccination coverage.

MSF is an independent, neutral, impartial medical organisation, which works in Yemen to assist people affected by the conflict on all sides of the frontlines. MSF works in 13 hospitals and health centres across the country and provides support to more than 20 hospitals or health facilities across 12 governorates: Abyan, Ad-Dhale’, Aden, Amran, Hajjah, Hodeidah, Ibb, Lahj, Saada, Sana’a, Shabwa and Taiz.

Cholera Treatment Centre (CTC) in Abs town, Hajjah governorate of Yemen. When the cholera and acute watery diarrhoea outbreak began, at the end of March, MSF set up two isolation rooms in Abs Rural Hospital. These were sufficient for the onset of the epidemic, but soon were overflowing. Following the rapid spread of the disease in May, the team decided to open a CTC in a school that is back-to-back with the facility. Photographer: Gonzalo Martinez. Date taken:  05 July, 2017
Water scarcity is one of the most serious problems in Yemen in general and Abs in particular. The situation in displacement settings is particularly worrying, utterly neglected and less resilient to external shocks. Sanitation is another critical issue, as many households do not have latrines nearby and open defecation is common. Poor hygienic conditions contribute to it being a breeding ground for epidemics such as the ongoing cholera and acute watery diarrhoea epidemic. Photographer: Redhwan Aqlan. Date photo taken: 21 December, 2016
Unlike in other places, there are no big and structured camps for internally displaced people (IDPs) in Abs: they are generally living in informal settlements – sometimes close to villages/towns, sometimes detached. The usual pattern in the region is groups of households in rudimentary accommodations spread near main roads or deserted areas. Many people are willing to sacrifice their wellbeing and access to services, just to be the furthest possible from ground fighting and airstrikes. Photographer: Redhwan Aqlan. Date photo taken: 21 December, 2016
People fetching water in Abs, Hajjah governorate, reflecting the direct and indirect effects of the war in Yemen: near the frontlines, the region is home to constant armed clashes and violations of international humanitarian law; it hosts a large number of uprooted people; medical care and other basic social services are widely unavailable; and humanitarian assistance for the most vulnerable remains insufficient. Not surprisingly, the cholera and acute watery diarrhoea epidemic is taking a heavy toll on these rural areas, with thousands of people sick and dozens of deaths. Photographer: Gonzalo Martinez. Date photo taken: 05 March, 2017
María José ‘Quesé’ Blanco is a Spanish nurse responsible for the outreach activities of MSF in Abs. She has been working in Yemen since November 2016, in four different locations. These mobile clinics provide out-patient services for internally displaced people and host communities across the district, including regular consultations, emergency referrals, ante-natal care and mental health. Photographer: Gonzalo Martinez. Date photo taken: 05 March, 2017
An MSF team on its way to a mobile clinic in Abs district, while four children on their donkeys go to fetch water. Water is one of the most pressing needs for displaced people, together with food, medication, shelter and protection. Rain is considered to be a destabilising factor, as it floods tents and rudimentary houses. Photographer: Gonzalo Martinez. Date photo taken: 05 March, 2017
Donkeys are essential animals in rural areas, especially as a means of transport and/or of fetching water. The so-called ‘blue gold’ is increasingly scarce across Yemen, and Abs district is no exception. Free water systems are barely working, and trucking provision is also limited at the moment, leading the most vulnerable to drink unsafe water in order to survive. Photographer: Ainhoa Larrea. Date photo taken: 24 February, 2017
Angela Makamure Press Officer at Doctors Without Borders (MSF) Southern Africa