Like the dialysis center, hospitals in Yemen are ground zero for the humanitarian crisis.
The health system is in “a state of collapse,” according to the World Health Organization. More than 600 health facilities have stopped functioning due to a lack of fuel, supplies and personnel. More than 15 million Yemenis — well over half of Yemen’s population — now lack access to health care.
Visit any medical center — from Sanaa to Saada, Hajjah to Hudeidah — and the hardships are similar: medical shortages, frequent power outages, not enough staff and a ballooning number of patients.
Al-Thawra hospital is the largest medical facility in Yemen. The massive complex sits in the heart of the capital. Despite its stature, al-Thawra is also suffering from an acute shortage of medical supplies. Even basic items like rubbing alcohol are scant. The hospital has not been able to perform heart surgery for two months due to the dearth of proper anesthetics and medicine. The dialysis center has been closed for two months without the replacement tubes and dialysis solution necessary to run the machines. Even the plastic booties for visitors to cover their shoes have run out; the cardboard boxes at the ICU entrances hang empty.
Near the end of October the hospital began to run out of sutures, forcing them to use makeshift stitches that threaten to tear open.
“We are calling for help as soon as possible. From everywhere, from everyone to be able to run facilities or patients, otherwise we will simply have to stop,” said Dr. Abdul Latif Abotaleb, a surgeon at the hospital for 20 years and its deputy director for the past three months. He adds that many people have died because of a lack of available medicine, mainly kidney and heart patients.
As supplies and staff run short, hospitals in Yemen are overwhelmed. Nearly 27,000 people were reported wounded in the conflict as of mid-October, according to the United Nations. Disease outbreaks, including malaria and dengue fever, have made matters worse. Meanwhile, with the limited care available, people are dying from chronic ailments that are easily treatable. Cancer, diabetes and high blood pressure account for 39 percent of all deaths right now in Yemen.
Like health facilities across the country, one of al-Thawra’s main problems is limited fuel. The hospital has barely had any for the last month and a half. They use the minimum amount possible to power the generators. Electricity is rationed for the ICU and surgery, while other sections of the hospital get power for two hours at a time.
“If the situation continues like this we will all die. The sick and the healthy,” Abotaleb said, adding that he has pled his case with the United Nations and international NGOs. But all he can do is wait. “We don’t know what else to do.”
Farther north, in Saada City, the Gomhouri hospital is one of the only ones left in the entire province. Doctors are forced to ration treatment. Patients who are no longer in critical condition are sent home to make room for others. Rooms that were once clinics have been filled with cots and converted into recovery wards.
The pediatrics ward is filled with malnourished children. Some are crying; most are too weak even for that.
Radwan Saleh is just 16 months old. Emaciated, he lies supine and stares blankly into space. His mother sits beside him. Her village of Sagein near the border came under repeated bombing, so she took her children to live in caves in the mountains before finally returning. They had little food. Radwan developed diarrhea and began vomiting, forcing his mother to leave her other children and take him to Saada for treatment.
The hospital receives as many as 20 malnourished children a day, according to Adel Habes, the head of the pediatrics center. “There was always malnutrition in Yemen. But it has increased 300 to 400 percent because of the war. There are no markets, no milk, no food. Roads are blocked and there is nothing reaching certain areas,” he said. Mothers bring their babies in only when they are critical; they have other children to take care of and the trip is usually fraught with danger and prohibitively expensive.
The Gomhouri hospital is the only medical facility in all of Saada with a malnutrition center. Yet it is in desperate need of antibiotics, milk and other supplies. Since March, more than 190 health facilities providing nutritional services have closed due to insecurity or fuel shortages.
“We are lacking in medicines. All of Yemen has this problem but Saada is particularly bad,” Salah al-Shami, the deputy manager of the al-Gomhouri hospital, said. “We want the world to see what is going on. There are real crimes happening here.”
About 2 million are now acutely malnourished, including 1.3 million children — 320,000 of whom are suffering from severe acute malnutrition, the United Nations says. Chronic malnutrition in early childhood harms physical and mental development, putting children at a disadvantage for the rest of their lives.
Hudeidah is the poorest governorate in the Arab world’s poorest country. It had the highest levels of malnutrition in Yemen before the war. The conflict has sent the levels of malnutrition among children soaring.
The number of cases in Hudeidah has at least tripled, according to Awsan Qaied, the head of the severe acute malnutrition center in Hudeidah’s Thawra hospital. That means more children are dying. Infants with severe acute malnutrition have a 75 percent chance of dying from related complications. “Stop the war, stop the siege and they will get better,” Qaied said.
Adnan Abdulfattah, the head of UNICEF’s office in Hudeidah, said the aid agency’s efforts to reduce malnutrition over the past three years were erased within 4 to 5 months.
“Yemen is probably the worst humanitarian situation in the world,” Abdulfattah said. “People think Somalia is the worst, but Yemen I think is the worst, especially in this part of the country.”
There was a time when Somalis fled to Yemen to escape famine and war. Now they are fleeing the other way.
THE ECONOMY
Yemen’s northern province of Saada, the birthplace and homeland of the Houthi movement, is one of the worst-hit areas in the country. In May, the Saudi-led coalition declared Saada City, home to 50,000 people, a “military zone” and gave civilians a few hours to leave.
The ineffable destruction in Saada is difficult to absorb. Airstrikes have reduced whole neighborhoods to rubble. And they have destroyed almost all civilian infrastructure. Anywhere people once gathered — all the places of communal interaction that breathe life into a city — have been bombed.
The Saudi coalition has targeted nearly every single market, or “souq,” and commercial life has come to a standstill. The Old City is a ghost town. All that remains of its thriving main souq, where residents of other towns once traveled to shop, are empty streets and alleys bordered by rubble. Shops and stalls that sold everything from spices and vegetables to electrical appliances and gold have been razed. The airstrikes came in successive waves, destroying hundreds of stores, and with them hundreds of livelihoods. People who were poor before the war are now barely surviving.
Like his father before him, Saleh al-Tumeri, a wiry 50-year-old with brown teeth and wispy white stubble, sold seeds and “tamr” from his shop in the souq for decades. It was his only source of income. After it was bombed in May he lost everything. “All my goods were destroyed and burnt,” he said. He now hawks his wares on the street but earns a fraction of what he used to. On bad days all he can afford is some rice and a quarter of a chicken to feed his family of 12.
Mahmoud Ali Malek, a guard at the souq, points to where various shops once stood. “It is painful to walk through here. These shops were owned by poor people,” he said. “This was their one source of income.”
Mohsin al-Khatib, a government employee who worked in the electricity sector, says that 95 percent of the city’s electrical facilities have been bombed. What little fuel arrives to Saada is too expensive for most residents to run generators. “We are living like widows in mourning,” he said. “Life here is all misery and struggle.”
On the city’s main thoroughfare, rubble lines the streets where shops once stood. Restaurants, homes, banks, pharmacies, and barber shops have all been hit. Before it was bombed, Ibrahim al-Aqwa used to rent the ground floor of his family home to several retail stores. Like many Yemenis, when asked where he will get money now that his main source of income is gone, he points to the sky. “Life has gone down the drain for us,” he said.
The conflict has crippled economic life on a national scale.
Gross Domestic Product is expected to go from $13.3 billion in 2014 to $8.7 billion in 2015, a decline of 35 percent, according to Yemen’s Ministry of Planning and Cooperation. That leaves real GDP per capita at an alarming $326. More than 2.5 million people have lost their jobs. Meanwhile, soaring prices have depleted household savings.
All across the country, Yemenis are struggling to survive.
Amina Saleh Abdullah al-Najar lives with her eight children in Dahr Hamiyet, a warren of narrow alleys on the west side of the capital.
The small three-room house is dark and sparse, almost cavelike. A small window lets in the daylight. There is no electricity, of course. The only source of light in the evening is a small flashlight with a battery that she charges from a neighbor’s motorcycle.
Amina has been living here for the past seven years. Her husband died 11 years ago. The burden of poverty and a life of manual labor and housework have left deep wrinkles around the eyes of the 55-year-old widow, the only feature visible behind her niqab. Her hands are thick and coarse.
After dawn prayers she heads outside, scavenging for four to five hours to collect plastic bottles from the rubbish-strewn streets, which she then sells to middlemen who sell them to factories. Before the war she would be paid about 1,000 riyals for 10 kilos worth of plastic. With factories producing little, she now only gets 200 riyals. With that she has to pay her rent and feed her eight children. It is never enough.
“The war has affected us in every way,” she said.
Often she goes to restaurants and neighbors to beg for food. Her children frequently have no lunch and no dinner, going to bed with growling stomachs. Water deliveries from a local charity all but stopped two months ago and she now has to pay for water to cook, clean and drink. It costs 20 riyals for 20 liters. Gas is scarce and prohibitively expensive because of the siege. She goes to a local market to buy wood and makes small fires in the alley outside her door to cook her family’s meals.
When asked what she will do if prices continue to climb, she throws her hands in the air. “We will try to live, what can we do?” she said. “Otherwise we will just slowly die here.”
THE WORST-OFF
One of the most dire humanitarian situations is in Taiz, Yemen’s third-largest city some 120 miles south of the capital. In addition to suffering the effects of the coalition blockade, the city is also under a vicious internal siege by the Houthis. “The situation in Taiz is very much a microcosm of the entire situation in the country,” Jensen, the head of OCHA, said.
Battle for control of the city among an array of militias and Houthi forces and their allies heated up in September. The Houthis retreated to the outskirts of the city and have blocked nearly all routes in and out. Aid agencies and residents say the Houthis are preventing nearly any commercial goods or humanitarian aid from entering the city.
“Despite repeated attempts by UN agencies and our humanitarian partners to negotiate access and reach people, our trucks have remained stuck at checkpoints and only very limited assistance has been allowed in,” the UN Under-Secretary for Humanitarian Affairs and Emergency Relief Coordinator Stephen O’Brien said in a statement in November.
Two-thirds of the population has fled Taiz. The 200,000 men, women and children who still remain are in desperate need of food, water and medical supplies.
Osamah al-Fakih, a researcher with the Sanaa-based Mwatana Organization for Human Rights, spent a week in Taiz in October doing research. He said Houthi forces have set up checkpoints on the main roads leading to the city and are conducting rigorous searches of anyone trying to enter. Trucks carrying food, fuel and medicine were parked on the side of the road and prevented from going in, al-Fakih said. The blockade is so extensive that Houthi forces are even confiscating bags of groceries, like potatoes or flour, or small fuel containers carried by individual citizens. “I left Taiz very depressed by what I saw,” al-Fakih said.
Residents try to describe the nightmare. Civilians are caught between coalition airstrikes and shelling by Houthi forces. The rubble-lined streets are empty after dark. Most medical facilities have shut down; restaurants and grocers are closed. Much of the population is displaced within the city. There is no electricity and little cell phone reception.
“These people have already suffered extreme hunger, and if this situation continues the damage from hunger will be irreversible,” World Food Program Regional Director Muhannad Hadi said in October. The aid agency said the last UN food aid to reach Taiz had arrived more than five weeks earlier.
Om Farid fled Taiz in October after her 6-year-old son, Farid Shawky, was fatally wounded in a mortar attack as he was playing hide and seek in their residential neighborhood. A video of the boy in the hospital shows him bleeding as doctors tend to his injuries. Through tears he pleads twice in a soft voice to his father, “Don’t bury me.” He died four days later. Relatives buried him; his parents could not bring themselves to do it. The video quickly went viral and became a symbol of Yemen’s suffering.
She says the situation in Taiz had become intolerable. “We were hungry all the time and there was little water,” Farid said. “Food has become so expensive. We ate very little. People were praying for rain just to get some water.”
Taiz once had 20 hospitals but now only six are functioning, according to Doctors Without Borders.
Doctors are desperate for oxygen tanks in order to be able to perform surgery. “We have withstood shortages of medicine, food and water, but oxygen we can’t,” said Dr. Nishawi al-Hami, the head of the emergency room at al-Thawra hospital in Taiz, in a phone interview. “Any patient needing an operation will die if we don’t get more oxygen. People will die every day.”
Al-Hami says staff are working to smuggle supplies on horseback through mountain paths that bypass the main Houthi-controlled roads. “It’s a disastrous, terrible situation, we are lacking everything,” he said. “We are living a humanitarian disaster in Taiz.”
Maher al-Absi, a local activist who works with UNICEF, says he tried to bring desperately needed dialysis solution into the city but was promptly arrested by Houthi forces, who confiscated his supplies. “The Houthis are trying to put pressure on the resistance but they are punishing civilians,” he said.
In October, Doctors Without Borders said that despite weeks of negotiations with Houthi officials, stocks of essential medical supplies were stopped at Houthi checkpoints.
“It is very frustrating that, after weeks of negotiations, we have made no progress in convincing officials of the need to provide impartial medical assistance to the victims of the ongoing fighting within this enclave, despite the continued support we are providing to health facilities in Houthi-controlled areas,” Karline Kleijer, the group’s emergency manager for Yemen, said in a statement.
Saudi officials often point to the siege of Taiz as evidence of rights violations committed by the Houthis. Yet instead of trying to send in humanitarian aid, coalition warplanes have repeatedly dropped weapons to the local militias fighting the Houthis.
“Both sides are using aid as a weapon and they’re using the suffering of the Yemeni people as a political tool,” said Baron, the analyst from the European Council on Foreign Relations. “Until now no side in the conflict has showed any willingness to take firm action to alleviate the suffering of the Yemeni people.”
As the conflict grinds on into its nine month, the level of suffering in Yemen has garnered relatively little attention in the international press.
“It’s important that Yemen is being reported widely in the media so people are conscious of what is happening here,” Jensen, the head of OCHA, said. “The situation is very, very dire and the only solution to end the suffering is peace. We are trying to press all parties to the conflict to go to the negotiating tables in good faith and find a solution for the sake of the people of Yemen.”