Holding Human Health Hostage In Yemen

Despite the widespread violence of the war in Yemen, most Yemenis are not dying of explosions or gunfire. They are dying due to a multi-faceted breakdown of the country’s entire medical system.
Holding Human Health Hostage In Yemen

The United Nations (UN) has reported that the number of civilian casualties from the war in Yemen is well above 6,600. The actual number is certainly higher, however, after taking into account the number of victims of hunger due to the coalition-imposed blockade on the country since 2015, victims of illnesses and epidemics, the shortage of medication, the destruction or shutdown of hospitals and health centers, and the shortage of fuel and electricity.

In mid-2017, Mahmoud Abdul Karim, 45, sold furniture from his home in Sanaa, Yemen’s capital, to cover the price of two medical treatments for his wife, who is suffering from cancer. Abdel Karim’s life was affordable before the war, but he has exhausted his resources and become increasingly unable to provide adequate medical care for his wife.

Safaa Alhabal, who launched the Be Positive (Be+) initiative, told Inside Arabia that her project receives sponsorships from donors to provide many of the highest-priced medicines on the market to a handful of the most critical patients at no cost. However, given the collapse of the health situation throughout the country, these types of initiatives seem to be in short supply.

Abdul Karim’s wife is one of 30,000 people with cancer in Yemen who are in need of treatment and emergency assistance, according to global health estimates as of October 31. Children account for 10 percent of these cancer patients.

Abdul Wahab al-Nahmi, deputy director of the Sanaa Cancer Center, said many patients were not registered and were not being treated in cancer centers. Among those registered, “about 500 people die each year,” reported a Sanaa-based cancer center in April 2017.

Since the beginning of the war, many Yemenis have been killed in violent acts, but most have died because of reduced access to health care, a preventable problem.

Since the beginning of the war, many Yemenis have been killed in violent acts, but most have died because of reduced access to health care, a preventable problem. In an effort to achieve their ends, combatants are using health (or, more precisely, the lack of it) as a weapon against civilians whenever they believe that the effectiveness of bullets, missiles, and landmines is insufficient.

Access to health facilities has been the most deadly weapon used against Yemenis. According to the UN, the war has disrupted 50 percent of health facilities and medical personnel in 18 percent of Yemen’s districts. For example, since the beginning of the war, dialysis treatment sessions for patients with kidney failure have been halved to a single session per week.

By September 2015, at least 160 health centers had been closed due to conflict-induced insecurity. By 2016, 600 medical facilities had been closed due to damage sustained in deliberate military attacks and the shortage of basic medical equipment and personnel, according to the UN. Approximately 70 medical facilities have been completely destroyed.

The tactic of targeting such facilities has devastated Yemen’s health sector. Healthcare workers have been displaced and driven out due to wage interruption, indiscriminate targeting, the absence of medicine, smuggling, and the falsification of medications for patients with heart disease, cancer, and other chronic illnesses. With the high demand driven by lack of access to healthcare, some companies are even selling placebo medications to critically ill patients at exorbitant mark-ups.

Health has been weaponized by the Houthi rebels, the Hadi government, the Saudi and UAE coalition forces, and their loyal local fighters. The coalition’s import restrictions have worsened the country’s dire humanitarian crisis. The coalition has delayed and diverted tankers closed major ports, and prevented the entry of goods into Houthi-controlled seaports. Both parties have further obstructed the flow of fuel required to operate electric generators in hospitals and have stopped water from being pumped to civilian homes.

While hundreds of Yemeni civilians die every day, the world does not count them among the victims of this war. They have been dying for more than three years, but without publicity, without noise, without announcement, without condemnation, without a bold international outcry, and without basic human rights. UN reports have reported the deaths of 6,600 civilians, most of them in the aftermath of coalition air strikes. However, they assert that the actual number is much higher.

In early November 2018, armed Houthi men positioned themselves on the roof and perimeter of Al-Thawra Hospital in Hodeidah to prepare for a clash with the Hadi government, which was supported by Emirati and Sudanese forces.

In early November 2018, armed Houthi men positioned themselves on the roof and perimeter of Al-Thawra Hospital in Hodeidah to prepare for a clash with the Hadi government, which was supported by Emirati and Sudanese forces. In March, a missile attack against UAE-backed government troops targeted a hospital gate and a fish market in the town of Hodeidah, killing 55 civilians and injuring 170.

Recently, the high humanitarian cost of the war waged by the alliance in Yemen has become a global priority. International outrage over the murder of Saudi journalist Jamal Khashoggi has led a number of Western leaders to reconsider their support for the war.

Since the attack on Hodeidah began in June, the civilian death toll has increased by 164 percent, according to the Armed Conflict Location & Event Data (ACLED) data. More than 50,800 families have been forced to flee to the capital to escape lack of safety and security, increasing poverty, malnutrition, and epidemics, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA). The majority of displaced persons were the elderly, pregnant women, people with chronic illnesses, and those with children.

One of the main justifications tendered by the coalition for extending the war and the assault on Hodeidah is the allegation that Houthi rebels receive Iranian weapons through the port and obstruct humanitarian aid. Both the Houthis and Iran deny this allegation. But if the coalition takes control of the Hodeidah port, the last vital port still under Houthis control, the blockade and humanitarian situation will get worse. This port is the entry point for 80 percent of the food and aid coming into Yemen.

Parties to the conflict continue to prevent and restrict civilians from accessing essential aid. For example, the Saudi-UAE coalition has imposed a naval embargo on Yemen and prevented the entry of life-saving food and medicine. Shipments of fuel and cargo remain aboard ship for long periods before they are allowed to enter, and the UN estimates that more than half of the Yemeni population is in desperate need of humanitarian assistance.

The Houthis and allied forces have also confiscated food and medical supplies from civilians entering Taiz and prevented humanitarian aid from reaching the city, contributing to a near-total collapse of the health system there, according to a 2017 Human Rights Watch report.

Before 2015, Yemen relied 85 percent on imported drugs and 15 percent on locally manufactured drugs. The blockade quickly destroyed all medicines, including milk for children, as well as vaccines and medicines for diabetes, kidney failure, asthma, tuberculosis, and cancer.

According to Ehsan al-Rabahi, head of the Yemeni Union of Drug Producers, imports of medicines fell by 50 percent in the first half of 2016. Domestic production fell by 70 percent due to the inability to import the raw materials from abroad.

Drug prices increased by 200 percent as a consequence of the depreciation of the currency against the U.S. dollar. As a result, the black market increased significantly and “the proportion of medicines smuggled into Yemen represents more than 80 percent of the size of the drug market,” according to the local press.

Mohamed Mustafa, 48, recently told Inside Arabia that the options available to diabetic patients are terrible: Either “there are drugs that have been smuggled in at half price, but are unusable due to poor storage, or a good drug [is] four times more expensive than before.”  

About 16.4 million people, 9.3 million of whom are in urgent need, who live in 215 Yemeni districts do not have adequate access to health care services. UN reports show that this represents an increase of 79.3 percent since the end of 2014. Yemen’s main health problems since the beginning of the war have been malnutrition and gastroenteritis due to the lack of medicines and clean drinking water; these diseases have become epidemics in most parts of the country.

Since April 2017, the country has witnessed more than 1.2 million suspected cases of cholera with 2,515 deaths, leading to one of the worst epidemics in recent history. With the outbreak of diseases and epidemics, immunization is a matter of life and death for millions of Yemenis, especially children. According to the World Health Organization, a child dies every 10 minutes from preventable causes in Yemen.

Three months after the start of the military intervention, the Yemeni Ministry of Health announced that stores had run out of many medicines. The ministry called on international organizations to respond urgently and help the thousands of people in Yemen with chronic diseases such as kidney failure, cancer, and diabetes, in particular, affected by the “severe land, sea, and air blockade.”

The Ministry of Health reported the number of cancer cases in Yemen at 25,000; the number of kidney and liver transplants and other organ recipients at risk of urgent relapse at 2,050 cases; and the number of people on dialysis in public institutions at over 4,000 cases, not including military and private hospitals.

Attacks on basic infrastructure such as health centers, food stores, pharmaceutical factories, water systems, and food distribution centers are still an everyday reality for Yemenis.

With a health system on the brink of collapse due to military actions on both sides, a shortage of medical supplies, the fact that most health workers have not been paid for three years, and the reality that children are at a greater risk of developing diarrheal diseases caused by acute malnutrition, the disaster and the suffering of the victims in Yemen continues.

Hundreds of photos of malnourished and emaciated Yemeni children are available for the world to see. The international community digests these images and dire reports of the situation daily, and officials at the UN, in the U.S., and around the world are increasingly aware of the developments in Yemen.

Yet, the international community largely prefers to ignore the overwhelming amount of information provided by human rights reports, and testimony of journalists and medical experts. Instead, it continues to approach the war in Yemen, and the world’s worst, man-made humanitarian crisis it has caused, as a mystery rather than a tragedy.