YEMEN: Urgent need for improved water and sanitation to curb cholera in Abs region

Thursday, July 13, 2017 — Abs, Yemen

An urgent scale-up of aid is needed in the northern district of Abs, the area worst affected by Yemen’s cholera outbreak, according to international medical organisation Doctors Without Borders (MSF). The disease is spread by contaminated water, so water and sanitation activities are particularly vital to tackle the problem at source, says MSF.

“In Abs district, our teams are seeing an extremely poor sanitation situation and insufficient access to clean drinking water,” says Gabriel Sánchez, MSF programme manager for Yemen. “This is clearly a main factor in the spread of the current cholera outbreak. Water and sanitation was an issue even before the cholera outbreak, but it is especially concerning now. Either we act now or we will face an even bigger humanitarian crisis in the weeks and months ahead.”

Abs, in Hajjah governorate, registered its first cholera case in late March. Since then, the number of cholera cases has exploded, with MSF’s cholera treatment centre in Abs town receiving as many as 462 patients in a single day – more than anywhere else in Yemen.

With more than 376,000 displaced people among an estimated population of two million, Hajjah hosts more displaced people than any other Yemeni governorate. About a quarter of these are sheltering in Abs district, often living in remote areas without basic services so as to lessen the chance of being targeted by airstrikes or other types of violence associated with the conflict.

In the cholera treatment centres set up by MSF in Hajjah governorate, teams are distributing disinfection kits, which include mops, brooms, and soap and chlorine tablets for purifying water supplies.

“As well as treating patients, their houses need to be disinfected and water sources need to be chlorinated,” says Cristina Imaz, MSF logistics coordinator. “Clean water distribution points need to be set up, and places where people gather – like markets and bus stations – need to be sprayed regularly. However, these activities are not being done systematically at present.”

Since cholera broke out in late-March, MSF has doubled the scale of its emergency response in Abs district. MSF teams in Abs have treated more than 12,200 patients with suspected cholera and acute watery diarrhoea. This figure represents one-fifth of all cases seen by MSF’s teams across nine Yemeni governorates, and nearly five percent of all cases registered across Yemen, according to the World Health Organization (WHO). After two months of exponential growth, the weekly number of cholera cases dropped for the first time in early July, but people with the disease are still arriving for treatment in their hundreds.

Even before the cholera outbreak, MSF teams in Abs rural hospital were seeing substantial increases in emergency consultations, paediatric admissions and surgical interventions. There have also been outbreaks of measles and whooping cough and peaks of malaria – all diseases that should be either limited or controlled. Together, these are a clear sign that Yemen’s health system, desperately short of resources and staff, has collapsed.

MSF began supporting Abs rural hospital in July 2015. On 15 August 2016, an airstrike hit the hospital, killing 19 people, including one MSF staff member, and wounding 24 others. Shortly afterwards, MSF withdrew its teams from a number of health facilities in northern Yemen. In November 2016, MSF resumed its support to Abs hospital; currently MSF has some 200 Yemeni staff and 12 international staff working there. MSF manages the hospital’s emergency room, paediatric unit, maternity ward and nutrition centre, and provides mobile clinics and psychosocial counselling sessions.

Ali al-Qaifi came to the Abs hospital with his daughter, who has been suffering from malaria since months. Because of lack of treatment the girl suffered complications, and her father was desperate to find help for her. <br/>“My family back home is sick, too, with all kinds of illness in the air. We have a family in the neighborhood suffering from Cholera and Anemia. Everybody is sick and in rough shape, and their poor financial condition does not enable them to move from one health center to another. It’s all because of this war and these epidemics. Cholera is everywhere; the water is contaminated and I don’t drink it. Photographer: MSF
Ayed al-Malki from al-Sharq directorate accompanied patients to Abs hospital after cholera erupted in his town. They tried seeking help in the closest health center, but there was no cholera treatment available there:<br/>“We went to public hospitals, but we didn’t find any services. There were absolutely no services in the public health center in the directorate.” Photographer: MSF
Dr Ahmad Hasan Azman, a General Practitioner in Abs hospital, works in the Nutrition department and the Emergency department.<br/><br/>"We get a lot of very complicated cases; people in bad situations. And when we ask the caretakers about the case, they say that they did not have enough money to take the patient to a hospital." Photographer: MSF
Emergency Department Supervisor, Ahmad Qassam.<br/>Ahmad has been working with MSF since five years. Last year he was in the Abs hospital when an airstrike hit the building. He survived the attack but some of his colleagues didn´t. <br/>Today Ahmad is a supervisor of Emergencies department and treats war-wounded daily.<br/>“The situation is horrible. People before were living in their homes with dignity, having enough money to get through with their days. And even if they needed money, they’d borrow from friends. Now many people have lost their houses and livelihoods, some even lost part of their families.” Photographer: MSF
Kholah and Saher were malnurished and dehidrated. Once in hospital they were fed milk, as they hovered between life and death. Photographer: MSF
Sami (15-years-old) was brought to Abs hospital after an airstrike hit his parents farm in Al-Arf village.<br/>Him and his brother suffered serious injuries. Sami´s right foot was so severely damaged that his leg had to be amputated.<br/><br/>Now Sami needs regular surgical care in order to heal properly. Here he is pictured waiting for his wound to be cleaned by MSF doctors. Photographer: MSF
Zahra Hussein, patient of Abs hospital.<br/>She arrived to the Cholera Treatment center in Abs with her two small babies Kholah and Saher. Photographer: MSF
“In Abs hospital, the wards are bursting at the seams, as our medical teams do everything they can to meet people’s urgent health needs. What’s happening in Abs sums up the current state of Yemen. More than two years after the conflict escalated, the country has been torn apart. Many health facilities are not functioning, or are short of staff and medical supplies, and the health system has collapsed.” Roger Gutiérrez, MSF field coordinator in Abs, Yemen. Photographer: <br/>Igor Barbero/MSF