Five prior unsettled wars in Yemen’s northern Saada Governorate led to a sixth in 2009, the most intense so far. The Yemeni army ratcheted up its offensive against a rebel group drawn from the dominant community in the region, and the humanitarian fallout was unprecedented. Civilians and non-military targets such as hospitals were heavily affected by fighting. Hundreds of thousands were displaced and humanitarian assistance came to a virtual halt. A malnutrition emergency was discovered among children uprooted from their homes. For the first time, a foreign neighbour, Saudi Arabia, was drawn into the conflict, further complicating the plight of civilians.
Followers of the Al Houti movement have fought several wars in Saada against the state since 2004, claiming social, economic, political, and religious marginalization. The governorate is home to roughly 700,000 people. While the most recent “sixth war” began in August 2009, sporadic fighting in Saada in the spring injured dozens of civilians. MSF teams working in the hospital in the town of Razeh treated men, women, and children. The hospital itself and the MSF staff house were not immune from the violence, with the former struck by stray bullets and the latter nearly hit by errant shells. Fighting in the area restricted patient access to the hospital; slowing the facility’s daily emergency, surgical, and nutrition services.
Violence escalated sharply in August as Yemeni Army forces began carrying out air strikes and artillery assaults against Al-Houti rebels. Fighting raged in 13 of the governorates 15 districts, affecting almost the entire population. In November, Saudi forces entered the conflict, carrying out air strikes against rebel positions inside Yemen after a Saudi border guard was killed.
In the town of Al-Talh, MSF staff carried out 195 surgeries in August and September, 135 of which were people suffering from war-related injuries. But the violence ultimately forced MSF to halt its work in the town’s hospital. In mid-October, rockets struck Razeh Hospital, forcing its closure and the suspension of MSF activities there and the evacuation of staff. It was the last functioning health facility outside the town of Saada. Thousands of people per month had been treated in the two facilities and now the vast majority of the population was without access to any health care.
As another result of violence, thousands of civilians fled northward within Saada, and tens of thousands into neighboring Hajja, Amran, and Al-Jawf Governorates, all of which feature little to no healthcare services. While 35,000 people were registered as IDPs in neighboring provinces, and 45,000 within Saada, total numbers and exact gathering locations were difficult to ascertain because the violence restricted the movements of aid agencies. Many IDPs were reportedly staying with host families.
In Mandabah, in Baqim District, on the Saudi border, MSF intervened since mid-August providing health care services and an access to drinkable water to the thousands of displaced people in this region. Mid-November, MSF was able to establish a hospital in the town to serve both the resident and IDP populations.
In November as well, responding to a spike in malnutrition among displaced children in al-Mazraq camp, in Hajjah Governorate, MSF carried out an assessment in the area and found an 8 percent rate of severe malnutrition among children under five, leading to the opening of a nutritional intervention in the area.
The consequences of another humanitarian crisis continued to reach the shores of southern Yemen. Since the beginning of 2009, nearly a thousand smuggler boats carrying more than 50,000 Somali refugees and Ethiopian migrants have crossed the Gulf of Aden in search of safety and a better life in Yemen, representing a 50 percent increase compared to 2008. Passengers say that more than 100 people are routinely packed into the 30- to 40-person vessels. Many suffocate while others drown before they can reach the shore. By the end of the year, at least 266 people had drowned attempting the crossing and another 153 were missing at sea. MSF teams in southern Yemen provided humanitarian assistance to more than 5,600 refugees arriving on the beaches in 2009.