Crisis in Yemen
After 25 months of conflict, Yemen is a full-blown humanitarian emergency. The situation has progressively deteriorated since the war broke out, and airstrikes and ground fighting are having huge consequences for the civilians. All armed actors involved in the conflict, including the Saudi-led Coalition and the Houthis, are carrying out indiscriminate attacks without any respect for civilians or civilian infrastructures such as hospitals, schools or markets.
Doctors Without Borders/Médecins Sans Frontières (MSF) health facilities alone have been hit four times between October 2015 and August 2016. The last bombing, an airstrike on Abs hospital on August 15, 2016, resulted in 19 deaths and 24 wounded, including an MSF staff member. The UN reports that over 600 health facilities in the country have stopped functioning due to damages or lack of staff/supplies, affecting the access to healthcare of millions of people. Taiz city is one of the worst-affected areas of Yemen, with intense fighting including daily shelling in the densely populated inner city, and has not seen any ceasefire since July 2015.
MSF has been working in 13 hospitals and health centers in Yemen and providing support to more than 18 hospitals or health centers across 11 Yemeni governorates: Taiz, Aden, Al-Dhale’, Saada, Amran, Hajjah, Ibb, Sana’a, Hodaida, Abyan and Lahj, with nearly 1,600 staff including 82 international staff — making it among MSF´s largest missions in the world in terms of personnel.
Yemen in figures
- Population: 27.4 million (OCHA, January 2017)
- GDP / capita: US$1,400; 182th in the world (out of 228) (World Bank, 2015)
- Infant mortality: 89 per live 1,000 births. Under five mortality: 42 deaths per 1,000 live births (UN IG CME, 2015)
- 14.8 million people have no access to healthcare (OCHA, January 2017)
- Around 3.3 million children, pregnant women and new mothers are acutely malnourished, including 462,000 children under the age of five who are severely malnourished (OCHA).
- More than three million people have fled their homes in search of safety and security, out of which more than two million remain internally displaced and over one million have provisionally returned to their places of origin (Yemen Humanitarian Response Plan, January 2017)
Humanitarian crisis in Yemen needs to stop: MSF speaks out for more financial and diplomatic help
For more than two years, Yemen has been divided by a violent war. Doctors Without Borders/Médecins Sans Frontières (MSF) has been one of the few agencies providing aid and medical care to people affected by the conflict. On April 25, a gathering of international agencies and major funding organizations gathered in Geneva to discuss the crisis. MSF released the following statement:
Taiz: Healthcare Under Siege
After almost two years of continuous fighting, the medical-humanitarian situation in Taiz, Yemen’s third most populous city, is extremely dire and only seems likely to further deteriorate. Shelling, airstrikes, crossfire, landmines and snipers are consistently injuring, maiming and killing local residents, while access to lifesaving healthcare has become increasingly limited.
MSF has been working in 12 hospitals and health centres in Yemen and providing support to more than 30 hospitals or health centres in 11 Yemeni governorates: Taiz, Aden, Al-Dhale’, Saada, Amran, Hajjah, Ibb, Sana’a, Hodaida, Abyan and Lahj, with nearly 1,600 staff including 82 international staff — making it among MSF´s largest missions in the world in terms of personnel.
A growing number suspected cholera cases have been reported by the Yemeni Ministry of Health. MSF supports the Al-Sabeen hospital in Sana’a, and the Al-Sadaqa hospital and Al-Jumhori hospital in Aden, as well as other health facilities in Taiz governorate to help with the response. MSF is providing these health facilities with medical supplies and training of staff, in addition to logistical support with the aim of prevention, isolation of patients with suspected symptoms, case management and capacity building. Beside this direct support of medical facilities, MSF teams are continuously monitoring the situation to be prepared for any increase in cases, in addition to providing precautionary measures in MSF facilities in Aden, Al-Dhale, Amran, Ibb and Taiz.
MSF urges the international community to support Yemen’s fragile health system to cope with any needs.
In our projects, MSF staff have witnessed and treated several cases of malnutrition. Malnutrition is a complicated disease that arises from many factors. In Yemen, the issue of malnutrition is most notably exacerbated by the deteriorating economic conditions – which creates barriers for vulnerable communities to access medical treatment, restricts the ability to travel and the income to buy the necessary daily intake of food, among other factors – in addition to the general hardships resulting from the conflict. MSF strongly urges the international community to support the Yemeni population with their needs and to reinforce a collapsing infrastructure. From January to September 2016, MSF has treated 4,485 children suffering of malnutrition in Amran, Taiz and Hajja.
In 2017, MSF resumed its presence with an international team in Haydan hospital and runs the Emergency Room (ER), the maternity and the In-Patient Department (IPD). MSF provides assistance in the ER and in the maternity department of Shiara Hospital which was hit by a missile-rocket in January, 2016. MSF also supports health structures in Yasmim and Noshour.
In the district of Abs and through Abs Hospital, MSF is currently running the ER, the pediatric ward, the maternity and the emergency surgery with post-operative care, including mental health support for both patients and caretakers. In addition, MSF opened an inpatient therapeutic food centre (ITFC) within the hospital in early December.
Through a system of mobile clinics, MSF teams provide basic medical care to citizens in the conflicted district of Abs while monitoring the epidemiological and nutritional situation. Mental health services are also provided through outreach activities for the population in and around the settings of Internally Displaced People (IDP). This mobile clinic program was resumed in February.
Since August 2015, MSF has been supporting the main public referral hospital in Hajjah city in areas such as the ER, surgical services, Intensive Care Unit (ICU), and post-operation wards. In July 2016, MSF expanded its support to maternity services.
MSF runs the ER, the IPD, the ITFC, the Occupational Therapy (OT) and the maternity in Al-Salam hospital. It also supports health centres in Al-Qafla, Huth and Harf Sufyan districts through healthcare provision, donations of medication, oxygen, logistical equipment, electricity, human resources and a referral system. MSF is providing medical supplies, training personnel in emergency care, repairing and improving damaged structures, running ambulance, and reference systems in a number of health structures in Amran Governorate.
MSF continues supporting the emergency room in Al-Kuwait hospital in Sana’a. In addition, MSF is donating emergency supplies to Al-Jumhouri and Al-Thawra hospitals. MSF provides war wounded kits in the districts surrounding Sana’a, like Arhab, Nihm, Hamdan or Jihanah. MSF is also supporting the Mother and Child Hospital Al-Sabeen in Sana’a.
MSF supports HIV survivors
MSF continues to support the Ministry of Health´s HIV program in Sana’a. More than 1,750 patients from the capital and several governorates received their lifesaving anti-retroviral treatment in 2016. In addition, MSF is assisting with Voluntary Counselling and Testing as well as with Prevention of Mother to Child Transmission sites, in parallel to its advocacy work for the rights of people living with HIV who are fighting against the stigma and discrimination in health facilities.
Moreover, MSF is providing regularly blood testing kits to the National Blood Bank in Sana’a since September 2015.
Due to MSF’s inability to run activities according to its principles of independence and impartiality, MSF withdrew from Al-Thawra Hospital in Ibb on April 20, 2017. However, MSF will continue to support the Hospital for the following two months with donations and incentives. In 2016, MSF provided lifesaving care in the ER of the hospital treating over 41,000 patients, half of them critical, and reinforced the hospital’s capacity to manage a mass influx of trauma patients. MSF has obtained permission to independently assess other medical needs in Ibb Governorate to launch a new project.
In addition, MSF is still working in the General Rural Hospital of Thi As Sufal district. This hospital is the closest to one of the country’s violent war frontlines bordering Taiz Governorate. Taiz city is one of the worst affected areas of Yemen, with intense fighting including daily shelling over its fearful population.
MSF is directly providing emergency medical care, lifesaving surgeries, and working in-patient hospitalization for the most severe medical conditions. It also ensures mass casualty management capacity of the hospital. On average, our teams offer 250 consultations in the ER and perform 80 surgeries per week. Finally, MSF provides regular monthly donations to the maternity department, in addition to water, fuel and other support to the entire hospital.
Yemen’s third largest city, where most hospitals have closed due to the conflict, MSF is running lifesaving medical activities on both sides of the frontlines in Taiz. In Al Houban neighborhood, it runs a Mother and Child Hospital where almost 500 deliveries were recorded last month and over 2,500 severely malnourished children were admitted to the therapeutic feeding clinics supported by MSF in Taiz.
Additionally, MSF runs a Trauma Centre for war-wounded and trauma cases and covers referrals. In the enclaved city centre, MSF supports Al-Jomhouri Hospital for maternity services, Yemeni Swedish Hospital for pediatrics, Al-Thawra Hospital for medical and surgical ER, and Al-Rawdah Hospital for ER for war-wounded. Most of injured patients come from the city centre, where many civilians are caught in the middle of intense fighting, struggling for food and survival. The patients MSF sees in Taiz mainly suffer from injuries due to airstrikes, blasts, shelling’s, gunshots, snipers shots, and most recently from landmines. Movement in and out of the city remains restricted and dangerous for civilians and humanitarian actors. MSF is also providing medications to the ER and emergency OT supplies to Khalifa Hospital in Al-Turba.
Al-Dhale governorate is located on the old border between Northern and Southern Yemen, and besides being affected by the current conflict; it is also affected by ongoing tensions over the old border. The governorate has frontlines on three sides between pro-Hadi forces and pro-Houthi forces (Hamak, Taiz, Moreis/Damt).These areas saw intense levels of fighting in August in the form of armed clashes, snipers, shelling and rockets. The shelling’s along the frontline hit civilian houses and cars. MSF works in partnership with the hospital in Al-Dhale and districts health centres in Al Azariq and Qatabah, running emergency room, outpatient consultations, surgeries, in-patient services, patient referrals, pediatrics, nutrition program and maternity. The Emergency Room of the health centre in Damth, the only MSF location under Houthi control in the governorate, was supported after the increase of war-wounded people in the area.
MSF is running an Emergency Surgical Hospital in Sheikh Othman district, north of the city. The hospital offers free medical care in an emergency room, a hospitalization ward and an operating theatre, and provides mental health and physiotherapy consultations. MSF is still seeing victims of landmines and unexploted ordnance (UXO) coming from Aden, Taiz, Lahj and Al-Dhale’. A medical doctor and nurse conduct weekly visits so Aden Central Prison to provide primary healthcare services running an average of 50 consultations every visit.
Moreover, MSF is offering money incentives for technicians at the Prosthetic Centre and supporting the National blood bank with tests, special blood bags and reagents for the machines.
The Aden project is supporting several health centres and hospitals in the adjacent governorates as follows:
- Atturbah Hospital in Taiz: MSF supports the hospital with medications for the surgical activities, ER and incentives for some of the staff within it, besides providing some logistic and biomed equipment maintenance.
- Ministry of Health (Moh) advanced medical post in Dhubab district, Taiz: MSF is supporting the ER.
- MoH health center in Mocka, Taiz: MSF is providing punctual supports to the hospital.
- MoH Hospital in Lawdar, Abyan: MSF supports the hospital with medications for surgical activities and ER as well as incentives for ER and OT staff. Along with it, it supports transportation of patients to Aden by ambulance.
- MoH Hospital in Jaar, Abyan: MSF supports the OT and the hospital with medications for anaesthesia.
- MoH hospital in Ataq, Shabwa Governorate: MSF supports surgical and emergency activities.
- MSF has a clinic in Karesh, Lahj Governorate within a MoH compound to stabilize the wounded and trauma cases and transport the patients to MSF hospital in Aden. MSF is also providing incentives for the MoH staff working in the clinic with its staff.
- MoH health center in Naaman, Lahj governorate: MSF is supporting and training the staff in the health center , to restart the center and provide it with medications
- Two MoH clinics in Denaem/Zaher district in Al-Baida governorate: MSF is supporting these health centers with dressing materials, stabilization kits for trauma and basic medicines.
MSF started supporting the emergency room in the Ministry of Health Al-Olfy Hospital in Hodaida with medications and medical supplies. The support also includes incentives for 60 of the staff.
Other medical care provided by MSF
Since October 2015, MSF has been supporting dialysis treatment centres in Sana'a, Sa’ada, Hajja and more recently in August 2016, MSF started supporting two dialysis centers in Taiz and Mahweet. MSF brought in 240 tons of medical supplies for this activity alone. MSF supported the centres till December 2016 and The International Committee of the Red Cross (ICRC) will take over two centres. MSF is looking into the possibility to support three new centres.
MSF has progressively increased its mental health and psychosocial support activities across Yemen. The teams are composed of clinical psychologists and counsellors-educators, and target population includes survivors of violence and their families with special attention to war-wounded, internally displaced people and children. In 2016, MSF provided 5,700 individual and family sessions to roughly three thousand beneficiaries and their relatives. As well, it offered group interventions to sensitize local communities about mental health, reduce stigmatization, teach basic techniques for psychological hygiene, and to restore previous coping mechanisms. Recreational activities for the children hospitalized were part of this package. These activities continue.
Furthermore, regular trainings are being provided to medical staff in the MSF run or supported hospitals in different regions, in order to improve the referral system and understanding of psychological effects of exposure to violence. Mental health teams are also actively involved in mass casualty contingency planning and implementation.
#NotATarget: MSF health facilities hit by airstrikes/missiles in Yemen
Four MSF-supported facilities and one ambulance were hit by airstrikes or missiles within the first 10 months of the escalation of conflict.
Abs Hospital, Hajjah - August 15, 2016 at 3:45 pm
Hospital: Abs Rural Hospital
Location: Abs district, Hajjah Governorate, northwestern Yemen
Details: Aerial bomb hit the area where the Emergency Room is located and destroyed it along with other structural damage.
Death toll: 19, including one MSF staff: Abdul Kareem al Hakeemi
Status: 27 Aug Ministry of Health resumed maternity and emergency services
August 18 MSF evacuated staff.
November 24th MSF resume full scale activities in Abs hospital after major rehabilitation. Mobile clinics resumed in February
Shiara Hopsital, Razeh - January 10, 2016 at 9:20 am.
Hospital: Shiara Hospital
Location: Razeh District, Saada Governorate
Details: The missile/rocket hit a corridor leading from the main gate to the hospital buildings, with a metal fence alongside. The wounded were hit by shrapnel from the rocket, and also by shards of metal from the fence.
Death toll: Six killed
Injured: Seven people were seriously injured, including two staff members. Many others received shrapnel injuries.
Status: Ongoing investigation. MSF has not confirmed it was an airstrike.
Haydan Hospital, Saada - October 26, 2015, 10:30pm
Hospital: Haydan Hospital – MSF-supported
Location: Haydan District, Saada Province
Details: Airstrikes occurred over a two-hour period completely destroying the emergency and consultation rooms, maternity unit, or inpatient department.
Death toll: None - hospital staff and two patients managed to escape.
Injured: One staff member was slightly injured while escaping
Clinic in Al-Houban, Taiz - December 02, 2015 at 11:10 pm
Health Facility: MSF Clinic in hospital tent in area with high number of displaced.
Location: Taiz city, Al Houban neighborhood, Taiz Province
Details: An airstrike occurred 22 metres from a MSF mobile tent clinic, which had closed 30 minutes earlier.
Death toll: This airstrike injured nine people within the proximity of the tent clinic, including a MSF health educator and a MSF guard. One of the wounded persons died of his injuries the following day.
Status: The clinic closed after the airstrike as the population felt MSF’s presence caused the attack.
Living Beneath the Bombs in Yemen
- Read the full press statement on MSF's evacuation from North Yemen following hospital attack
- 'We refuse to accept this': MSF demands answers for attacks on health facilities in Yemen
- 'We can’t just stop our life because of the war': A Canadian nurse reports from the front lines in Yemen
Médecins Sans Frontières/Doctors Without Borders (MSF) teams have treated tens of thousands of war-wounded since hostilities increased in 2015, despite the difficulties caused by ongoing violence, fighting and a fuel blockade that continues to cripple the country.
- 'People are suffering on a daily basis': MSF calls for action in response to the humanitarian crisis in Yemen
- Yemen: Delivering emergency care amid extreme violence and continuing conflict (SLIDESHOW)
Video: A Canadian nurse on coming under fire in Yemen
In the video above, Canadian Doctors Without Borders/Médecins Sans Frontières (MSF) nurse Céline Langlois describes getting caught in the crossfire of the ongoing violent conflict in Yemen.