Why are we there?
- Armed conflict
- Access to health care
Yemen: Latest MSF Updates
- Yemen: Urgent Need for Improved Water and Sanitation to Curb Cholera in Abs District
- "I don’t feel safe. I feel scared." Voices from Abs, Yemen
- Yemen: Cholera Outbreak Threatens to Spiral Out of Control
- Yemen: Increased Response Needed as Cholera Spreads
UPDATE: July 4, 2017
UPDATE: July 2, 2017
The number of suspected cholera cases reported by World Health Organization (WHO) and Yemen’s health authorities has reached 252,816, with 1,560 reported deaths. The epidemic that began on March 30 now includes cases reported from 19 of Yemen’s 22 governorates. The scope of this outbreak is significantly wider than the one that occurred immediately prior, between October 2016 and March 21, 2017, which saw 23,506 cases across 15 governorates, according to the WHO.
Poor sanitation and a lack of safe drinking water, both caused by the ongoing conflict, are increasing people’s susceptibility to cholera. Those also suffering from malnutrition are particularly vulnerable to cholera. As the outbreak spreads to more remote communities with even fewer services, people are increasing unable to access health facilities in time for treatment.
The overall collapse of Yemen’s health system is the key underlying cause of the spike in cases over the last weeks, as cholera treatment units managed by the Ministry of Health have been unable to deal with the high numbers of cases.
MSF has witnessed a sharp increase in suspected cholera patients at its facilities in Yemen. Between March 30 and May 30, MSF had treated 12,181 patients. By June 4, that number had nearly doubled to 24,135, and by July 2, the number of patients had more than doubled again to 60,631 suspected cholera patients treated since the outbreak began.
MSF is operating nine cholera treatment centers (CTCs), seven cholera treatment units (CTUs), and two stabilization units across nine governorates (Amran, Hajja, Al-Dhale, Hodaidah, Ibb, Taiz, Sana’a, Aden and Abyan) and continues to adjust its services as needed by opening new centers, supporting other facilities through donations of supplies and training, and continuously evaluating the needs.
MSF Cholera & Acute Watery Diarrhea Figures
MSF has treated 60,631 patients (cholera cases & acute watery diarrhea):
16,341 patients in Hajja Governorate (between March 30 and July 1)
10,042 patients in Ibb Governorate (between May 3 and June 30)
7,942 patients in Amran Governorate (between April 25 and June 30)
7,276 patients in Al-Dhale Governorate (between April 23 and July 2)
5,727 patients in Aden Governorate (between April 10 and July 1)
3,827 patients in Hodaidah Governorate (between May 19 and June 26)
4,139 patients in Taiz Governorate (between May 7 and July 2)
4,283 patients in Sana’a Governorate (between May 23 and July 2)
1,054 patients in Abyan Governorate received (between May 12 and July 1)
MSF Cholera Treatment Facilities Locations
99-bed CTC at a public school in Khamer
25-bed CTU at Huth Hospital
10-bed cholera stabilization unit at Al-Qafla
10-bed cholera stabilization unit Harf Sufyan
Hygiene kits are being provided to patients admitted to our facilities and to area households. Contents include one month’s supply of handwashing soap and water purification tablets, as well as four sachets of oral rehydration salts, a five-gallon jerry can to store treated drinking water, and detergent powder for jerry can cleaning. Health education is also being provided to patients and caregivers in the Khamer CTC.
As there is a huge need for improved hygiene and sanitation in the valley area, MSF will complete distribution of 3,000 hygiene kits by mid-July.
MSF is also implementing a comprehensive outreach strategy targeting the most affected areas to stop the chain of transmission. This includes setting up 15 oral rehydration points (ORPs) in the most affected districts of Khamer, Huth, Al Qaflah, Harf Sufian, and the Osman Valley, and training community members to run them.
125-bed CTC at a public school near Abs Rural Hospital in Abs town
100-bed CTC at a public school near Al-Jomhouri Hospital in Hajjah city
MSF's CTCs in Hajjah Governorate have treated hundreds of patients each day in recent weeks. Many people have traveled up to five hours to seek treatment. As of July 1, the Hajjah CTC had treated 4,727 patients, and the Abs CTC had treated 11,614.
MSF has set up nine CTUs across the governorate and is providing direct support to other local medical structures in the region through trainings, donations of supplies, supervision, a referral system, and incentives to public health workers in the most affected rural areas. The plan also includes the establishment of at least five oral rehydration corners to reduce pressure on the CTCs.
Apart from the treatment of patients, MSF’s main priority in Hajjah is outreach activities to help contain the epidemic. MSF is focusing on hygiene promotion in hard-to-reach areas and the chlorination of wells. Teams are also communicating awareness-raising messages to the local communities through community health workers and radios, and in collaboration with imams at mosques. In addition, MSF is providing hygiene and disinfection kits with clear home-use instructions to patients who come to our CTCs and their families.
20-bed CTU at Al-Salam Hospital, Qatabah
16-bed CTU at Al-Nasr Hospital, Addhale
14-bed CTU at Damt Health Center
10-bed CTU at Al-Azareq
20-bed CTU at Al-Olfy Hospital
30-bed CTC at a school in Al-Houban
4-bed CTU at MSF’s Mother & Child Hospital
100-bed CTC in Ibb city
80-bed CTC at Thi As Sufal General Rural Hospital
55-bed CTC at Al-Kuwait Hospital
MSF has been donating drugs for cholera management to three hospitals in the governorate, the 22nd of May Hospital, Al-Jomhouri Hospital, and Azal Medical Compound.
100-bed CTC in a new building that was made available by the Ministry of Health (MoH) at the Al-Sadaqa Hospital compound.
The capacity of the Al-Sadaqa CTC is still not adequate, as more than 150 patients arrive every day. Some patients have been admitted on mattresses placed on the ground. MSF is supporting the MoH in efforts to open more referral centers in Aden to ease the case load.
35-bed CTC in a dedicated zone of the MoH hospital in Lawdar.
In both Aden and Abyan, MSF is providing support by offering donations of supplies and infection control training to staff.
MSF currently works in 13 hospitals and health centers in Yemen and provides 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, Yemen is among MSF´s largest missions in the world in terms of personnel. MSF operations in Yemen had a budget of more than 110 million Euros for 2015 and 2016.
MSF resumed its presence in Haydan Hospital in February 2017 with an international team, running the emergency room (ER), maternity ward, and the inpatient department. MSF also provides assistance in the emergency room and in the maternity department of Shiara Hospital, which was hit by a rocket in January 2016. MSF also supports health structures in Yasmim and Noshour.
In Abs Hospital, MSF runs the ER, the pediatric ward, the maternity ward, and the emergency surgery with post-operative care, including mental health support for both patients and caretakers. In addition, MSF opened an inpatient therapeutic feeding center (ITFC) within the hospital in early December 2016.
Through a system of mobile clinics, MSF teams provide basic medical care to people in Abs District while monitoring the epidemiological and nutritional situation. MSF also provides mental health services through outreach activities for the population in and around camps for internally displaced people.
In Hajjah City, MSF has supported the main public referral hospital in the governorate in the ER, with surgical services, in the intensive care unit, and in post-operation wards since August 2015, and with maternity services since July 2016.
MSF runs the emergency room, inpatient department, ITFC, operating theater and the maternity unit in Al-Salam Hospital and supports health centers in Al-Qafla, Huth, and Harf Sufyan through health care provision; donations of medications, oxygen, logistical equipment, electricity, and human resources; and a referral system. MSF provides medical supplies, trains personnel in emergency care, repairs and improves damaged structures, and runs ambulance and reference systems in a number of health structures in Amran Governorate.
MSF continues to support the emergency room in Al-Kuwait Hospital in Sana’a. Additionally, MSF donates emergency supplies to Al-Jumhouri and Al-Thawra hospitals and provides war-wounded care kits in the districts surrounding Sana’a, including Arhab, Nihm, Hamdan, and Jihanah. MSF also supports the Al Sabeen Mother and Child Hospital in Sana’a.
MSF’s support to the Ministry of Health’s HIV program in Sana’a continues. More than 1,750 patients from the capital and several governorates received lifesaving antiretroviral treatment in 2016. In addition, MSF supports voluntary counseling and testing as well as prevention of mother-to-child transmission sites in parallel to its advocacy work for the rights of people living with HIV to fight the stigma and discrimination against them in health facilities. MSF has provided regular 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. MSF will continue to support the hospital for the next two months with donations and incentives. MSF provided lifesaving care in the emergency room of the hospital, treating over 41,000 patients—half of them in critical condition—in 2016, and reinforced the hospital’s capacity to manage mass influxes of trauma patients. MSF has obtained permission to independently assess other medical needs in Ibb Governorate to launch a new project.
MSF still works in the General Rural Hospital of Thi As Sufal District. The hospital is the closest to one of the country’s violent front lines bordering Taiz Governorate. MSF directly provides emergency medical care, lifesaving surgeries, and inpatient hospitalization for the most severe medical conditions. MSF also ensures mass casualty management capacity of the hospital. On average, MSF teams offer 250 consultations in the emergency room 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.
MSF runs lifesaving medical activities on both sides of the front lines in Taiz, Yemen’s third-largest city, where most hospitals have closed due to the conflict. In Al Houban neighborhood, MFS runs a mother and child hospital, where 458 deliveries were recorded in March and over 2,500 severely malnourished children were admitted to the therapeutic feeding clinics supported by MSF in Taiz.
MSF runs a trauma center for war-wound and trauma cases and covers referrals. In the enclaved city center, MSF supports Al-Jomhouri Hospital with maternity services, Yemeni Swedish Hospital for pediatrics, Al Thawra Hospital with medical and surgical emergency rooms, and Al Rawdah Hospital’s emergency room for war-wounds. Most of the wounded come from the city center, 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 caused by airstrikes, blasts, shellings, gunshots, and, most recently, from landmines. Movement in and out of the city remains restricted and dangerous for civilians and humanitarian actors. MSF also provides medications to the emergency room and emergency operating theater supplies to Khalifa Hospital in Al-Turba in Taiz.
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 front lines on three sides between pro-Hadi forces and pro-Houthi forces (Hamak, Taiz, and Moreis/Damt). Shelling along the front lines hit civilian houses and cars. MSF works in partnership with the hospital in Al Dhale’ and district health centers in Al Azariq and Qatabah, running emergency room services, outpatient consultations, surgeries, inpatient services, patient referrals, pediatrics, nutrition programs, and maternity services. The emergency room of the health center in Damt was supported after an increase in war-wounded patients in the area.
MSF runs an emergency surgical hospital in Sheikh Othman District, in the north of the city. The hospital provides free medical care in an emergency room, a hospitalization ward, and an operating theater, and provides mental health and physiotherapy consultations. MSF is still seeing victims of landmines and unexploded ordinance coming from Aden, Taiz, Lahj, and Al-Dhale’.
A medical doctor and nurse conduct weekly visits to Aden Central Prison to provide primary health care services. An average of 50 consultations are provided every week. MSF provides incentives for technicians at the prosthetic center and supports the national blood bank with tests, special blood bags, and reagents for the machines.
The Aden project supports several health centers and hospitals in the adjacent governorates as follows:
- Atturbah Hospital in Taiz
MSF supports the hospital with medications for surgical activities and the emergency room and incentives for some of the staff in the emergency room, in addition to providing logistical and biomedical equipment maintenance.
- MoH Advanced Medical Post in Dhubab District, Taiz
MSF supports the emergency room.
- MoH Health Center in Mocka, Taiz
MSF supports the hospital.
- MoH Hospital in Lawdar, Abyan
MSF supports the hospital with medications for surgical activities and the emergency room as well as incentives for emergency room and operating theater staff, along with transportation of patients to Aden by ambulance.
- MoH Hospital in Jaar, Abyan
MSF supports the hospital with medications for anesthesia and supports the operating theater.
- MoH Hospital in Ataq, Shabwa Governorate
MSF supports surgical and emergency activities.
- MSF Clinic in Karesh, Lahj Governorate
MSF runs this clinic inside an MoH compound to stabilize wounded and trauma cases and transport patients to the MSF hospital in Aden. MSF also provides incentives for the MoH staff working in the clinic.
- MoH Health Center in Naaman, Lahj Governorate
MSF supports and trains the staff in the health center to restart services and provide medications.
- Two MoH Clinics in Denaem/Zaher District in Al-Baida Governorate
MSF supports these health centers with dressing materials, stabilization kits for trauma, and basic medicines.
MSF supports the emergency room in the MoH-run Al-Olfy Hospital in Hodaida with medications and medical supplies and provides incentives for 60 staff members.
Since October 2015, MSF has been supporting dialysis treatment centers in Sana'a, Saada, and Hajja. MSF also began supporting two dialysis centers in Taiz and Mahweet in August 2016, bringing in 240 tons of medical supplies for this activity alone. MSF is looking into the possibility of supporting three new centers.
MSF has progressively increased its mental health and psychosocial support activities across the country. The teams are composed of clinical psychologists and counselor-educators who target a population that includes victims of violence and their families with special attention to war-wounded, internally displaced persons, and children.
In 2016 MSF provided 5,700 individual and family sessions to over 2,700 beneficiaries and their relatives, in addition to group interventions to educate local communities about mental health, reduce stigmatization, and teach basic techniques for psychological hygiene and to restore previous coping mechanisms. Recreational activities for hospitalized children were part of this package. These activities continue.
Furthermore, MSF provides regular trainings to medical staff in the MSF-run or supported hospitals in different regions to improve the referral system and understanding of the psychological effects of exposure to violence. Mental health teams are also actively involved in mass casualty contingency planning and implementation.
|August 15, 2016||Abs Hospital||Hajjah||19 killed, 24 wounded|
|January 10, 2016||Shiara Hospital||Saada||6 killed, 7 wounded|
|December 2, 2015||Al-Hoban Clinic||Taiz||1 killed, 8 wounded|
|October 26, 2015||Haydan Hospital||Saada||1 wounded|
This is an excerpt from MSF's 2015 International Activity Report:
Armed conflict escalated into a full-scale war in Yemen in 2015, exacerbating already massive medical and humanitarian needs and severely restricting access to healthcare.
The Houthis continued to advance in 2015, taking over the presidential palace in Sanaa in January. President Hadi fled to Aden, and a Saudi-led coalition supporting his government began airstrikes to recover lost territory, including the port of Aden. Meanwhile, the war allowed Al Qaida and Islamic State (IS) group fighters to reinforce their presence in the country. By year’s end, the United Nations estimated that 2,800 people had been killed and some 2.5 million were internally displaced. The healthcare system has been decimated: medical staff have fled the country, facilities have been destroyed and medical supplies cut. To read more about the situation in Yemen, see here.
MSF managed to maintain its operations in Aden when it was divided by a frontline. In other areas it also scaled up its activities during 2015 as much as security allowed, despite an attack that destroyed the hospital it supports in Haydan, Sa’ada governorate, on 26 October and another on its tented clinic in Al-Houban, Taiz governorate, on 2 December, which wounded nine. A fuel blockade hampered the delivery of aid, while fighting, shifting frontlines and airstrikes restricted the movement of people and humanitarian organizations.
Sa’ada governorate was one of the worst-affected areas. From March, there were daily airstrikes targeting many civilian areas, including healthcare facilities, and access to medical care was almost impossible in some districts. In April, MSF started supporting Haydan hospital’s emergency room and maternity services, but had to suspend activities following an airstrike in October. They could only resume in December, using an undamaged part of the building. In May, a team started working in Al Jomhouri hospital in Sa’ada city, providing emergency, inpatient and intensive care, and maternity and mental health services for a population of about 700,000 people. Over 6,110 patients were attended to in the emergency room, and over 2,900 surgeries were performed. In November, another team began to support the Shiara hospital in Razeh district. In 2015, more than 100 births were assisted every week and over 1,000 emergency room consultations were performed. Staff also assisted in Majz and Nushur hospitals towards the end of the year.
Intense conflict broke out in Ad Dhale governorate in April but had subsided by August, when the frontline moved towards Ibb. People were trapped in the conflict areas and there were many deaths resulting from war injuries. MSF expanded its support in Ministry of Health hospitals and basic healthcare clinics such as Al Salaam and Al-Azariq, providing outpatient and emergency consultations, surgery, inpatient care and reproductive healthcare. The teams carried out more than 60,000 outpatient and emergency consultations, performed over 700 surgical procedures and made around 1,000 referrals.
There was intense fighting in Aden between March and July. In Sheikh Othman district of Aden city, MSF continued to run the emergency trauma centre, comprising an emergency room, two operating theatres, an intensive care unit and an inpatient ward. Mental health and physiotherapy consultations were also provided. Bed capacity was increased from 45 to 74 to accommodate the surge in needs, including several mass casualty incidents involving over 100 wounded each time. Many of the patients were children wounded by landmines and unexploded ordnance. Overall, teams carried out 7,778 emergency consultations and 4,300 violence-related surgical interventions. During the peak of the conflict, emergency healthcare was available in three health clinics in districts where medical access was very limited.
Taiz city, with an estimated population of around 600,000, was the scene of intense fighting as of July. Some residents were trapped in an enclave under siege, and a blockade on medical supplies began in August, which has had a major impact on healthcare access. MSF donated medical supplies to hospitals on both sides of the frontline. On the Al-Houban side, MSF provided assistance to the military hospital, Yemeni International and Al-Risalah, and inside the enclave, MSF supported Al-Thawra and Al-Rawda hospitals. Altogether, MSF provided more than 15,400 emergency room consultations, 6,800 consultations for people with war wounds, 1,100 surgical interventions and 10,900 wound dressings. Relief items such as blankets, food and jerry cans were also distributed to displaced people in the city.
In November, MSF opened a mother and child hospital in the Al-Houban neighbourhood, providing emergency services and reproductive healthcare, and an outpatient department for children under the age of 10. Some 7,800 outpatient consultations and 7,500 emergency room consultations were completed.
MSF continued its project at Al-Salam hospital, providing emergency, maternity, inpatient and outpatient services and assisting in the laboratory and blood bank. As access to medical care in other healthcare facilities decreased, MSF scaled up its activities in Amran hospital, carrying out 3,000 surgical interventions and 28,200 emergency consultations. More than 5,500 patients were admitted to hospital and over 2,900 babies were delivered. MSF supported the health centre in Huth, completing 9,300 emergency consultations, and provided drug donations and training to three facilities in the north of the governorate. As displacement increased, MSF launched mobile clinics and helped with water and sanitation activities in Khamir and Huth.
In May, MSF opened a project supporting Beni Hassan health center, and offering medical aid to 15,000 internally displaced people through mobile clinics. The team provided outpatient consultations, and distributed relief items and up to 240,000 liters of water per day. In July, the programme moved to Abs hospital, a more comprehensive facility in Abs district, to provide a greater range of services, including emergency and maternal healthcare and surgery. Since August, MSF has supported Al Jamoorhi hospital in Hajjah city by responding to emergencies, treating war injuries, performing surgery and assisting in the inpatient department. Over 4,550 patients were received in the emergency room.
MSF continued its HIV programme at Al Gumhuri hospital in Sana’a city, providing antiretroviral treatment to 770 people.
Two cyclones hit the southeast coast of Yemen in November. MSF set up a mobile clinic in Mukalla to assist families who had lost their homes, and made donations to the local hospital and blood bank. Around 300 consultations were undertaken. Blankets, jerry cans and washing kits were distributed to 200 displaced families. About 50 kilometres away on the west coast, in the district of Borom Mayfa, the team set up 14 water tanks to provide water for over 400 displaced families.
Training is part of MSF's regular activities in the hospital in the form of on-the-job training for MoH doctors and nurses. MSF has one doctor and two nurses at a time in the hospital. Started in February 2016, the program has trained 14 doctors and nurses so far.
Support for Other Hospitals
MSF has supported Ibn Khaldoun Hospital in Lahj with regular donations of medical supplies since December 2015 and Al-Razi hospital in Abyan since February 2016. This support includes medications for the emergency rooms and emergency operating theater supplies for Lawadar Hospital Abyan and Al-Razi Hospital in Abyan.
MSF provided 700 screening test kits to the national blood bank in Aden to restart their blood donation activities.
At the end of 2015, MSF had 551 staff in Yemen. MSF has worked in the country since 1994.
Husni Mansoor – MSF nurse supervisor, working in Aden
“Our biggest fear is that the fighting will surround the hospital. Many times, when the clashes intensify, we go down to the basement. But this creates a different problem. Before we save ourselves, we move the patients who are in beds near the windows to a safe place. This has happened many times. We hear the sound of gunshots and shelling or airstrikes and we move all the patients to safe areas before finding a safe place for ourselves. Windows at the hospital have been broken more than once and bullets have entered, but no one has been hurt inside the hospital.”