Category: Refugee and Migrant Health

In 2017, only a few years into a brutal civil war, Yemen reported a cholera outbreak of one million cases, more than half of which were children, making it the worst outbreak in history. At the time, Yemen was already in the midst of what was considered a dire humanitarian crisis, with more than 20 million citizens affected. A year later, the situation has become even more critical, with the United Nations warning of “the worst famine in 100 years” within the next few months if the war continues. Many more Yemenis have died from lack of access to basic needs, such as clean water, food, medical care, and sanitation, than fighting.

Yemen was already considered one of the poorest countries in the world before the war, with low rankings on all indicators of human development. However, the war has completely devastated the nation and the health of its citizens. Multiple outbreaks of infectious disease such as cholera and malaria, high rates of food insecurity and malnutrition, tens of thousands of trauma-related injuries, and widespread mental distress have exhausted the healthcare system. Almost 80% of Yemeni children reported symptoms of post-traumatic stress disorder, an exceedingly high rate even when compared to other conflict-affected nations. Healthcare workers, many of whom have been unpaid for months or years, have been kidnapped, harassed, and killed, while hospitals have been directly attacked and bombed. Medical facilities are left with barely functional equipment, empty supply shelves, and sometimes no medical staff at all. One article detailed how the grandmothers of an infant born four months premature brought him to a hospital where they found no physicians, who had all walked out in protest the previous day after one of them was beaten up by one of the hospital guards. The grandmothers attempted to place the infant into an incubator themselves, but both machines were broken.

In April 2018, as long-term wars in Syria, Iraq, Afghanistan, and South Sudan rage on, as a probable Rohingya genocide in Myanmar goes into its second year, and as natural disasters strike with increasing frequency and strength around the world, United Nations Secretary-General António Guterres called Yemen the world’s worst humanitarian crisis. The International Rescue Committee reports that 16 million people (almost three quarters of the country’s population) cannot access basic medical care, with more than half of the country’s already limited health facilities destroyed. What is left of the health system is Yemen is almost entirely sustained by contributions of medicines, supplies, and money by international donors. An estimated 9.5 million people were provided some form of medical intervention by the WHO and their partners in 2017 alone. However, the politics of the conflict have rendered even this emergency care inconsistent and unreliable. Médecins Sans Frontières (MSF) has occasionally had to cease providing services in some parts of the country due to sustained attacks on their facilities and staff by both Houthi fighters and Saudi warplanes. An intermittent Saudi blockade on Yemen’s ports has prevented humanitarian agencies from bringing in food, medicines, and fuel, and even when supplies can enter the country, distribution networks are insecure due to airstrikes and combatants. Like many of the world’s worst humanitarian crises, the devastating circumstances are almost entirely man-made. It is not lack of money or resources that has brought Yemen to this point- the entirety of the budget that the Yemen Ministry of Health proposed for 2018 amounts to just three days of what Saudi Arabia alone spends on the war campaign.

Yemen would not be the first country to see the health and well-being of its citizens used as a bargaining chip in an intractable conflict. Alex de Waal, a professor at Tufts University and the Executive Director of the World Peace Foundation, called these types of man-made famines and humanitarian emergencies “economic war,” which is much more difficult to classify under international humanitarian law than a violent bombing campaign or overt starvation tactics. “The coalition air strikes are not killing civilians in large numbers but they might be destroying the market and that kills many, many more people,” he told The New Yorker. Couple destroyed markets with ruined medical facilities and it is clear that the quality of life of human civilians will be devastated for the long term. This is by no means a new wartime strategy. Perpetrators try to bring their enemy -combatants and civilians who are in any way affiliated with them- to the brink of humanitarian desperation to force concessions.

What is needed is immediate and meaningful action on the part of the actors involved in the war as well as the international community that is both providing the weapons and aid that sustain the conflict. Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, outlined three requests to ease the humanitarian burden in the country. First, he called for guaranteed safe access throughout all of Yemen so that aid agencies can provide goods and services. Second, he demanded an end to all attacks on health workers and facilities. Lastly, he insisted that civilian health workers who remain in Yemen must be paid for their vital services. Similarly, a report by the International Peace Institute recommends that the international community, especially the UN Security Council, enforce compliance to international humanitarian laws and norms. Humanitarian actors must also work to coordinate their responses by sharing data, involving local stakeholders, and collectively pushing against blockade efforts. While meeting immediate needs is the clear priority, prevention and long-term health capacity building must also be pursued to both avert widespread catastrophe and prepare for the Yemen that will remain after the war ends. None of these actions must wait for a political end to the war, which is the only way to truly protect civilian life and ensure basic access to the human rights of food, water, sanitation, and health. However, these actions can push back against efforts by all sides of the conflict to use the health and well-being of Yemen’s citizens as pawns in the achievement of their aims.