Let’s talk COVID-19: Crisis after catastrophe in Yemen

Avril Benoît:

Here I was already talking with the mute on I should know by now. I'm Avril Benoît and welcome. Thanks for joining us for this series that we're doing called "Let's Talk COVID-19." We've been doing this every couple of weeks and it's really important for us to stay connected with you over the course of the pandemic, when so many of us are separated. I also just want to acknowledge that today we're going to be talking about one of the places where we're working on the pandemic COVID-19, Yemen. At the same time our thoughts are very much with our colleagues in Beirut and all the people of Beirut. We are doing this live on Thursday, you may be watching it... the recorded version some days later. So certainly things are changing but since we heard of the massive explosion, our hearts really went out to everyone there and I just want to acknowledge how hard it must be for everyone who is a first responder trying to help.

For the teams of Doctors Without Borders, of Médecins Sans Frontières, we have numerous teams in different parts of the country including in Beirut and they've been working very hard to try to support the local capacity there to provide medical support. So we'll hear just a bit about that in a moment. I'm Avril Benoît, I'm the executive director of Doctors Without Borders in the United States. We are also known by our international name Médecins Sans Frontières, MSF is the acronym you'll often hear over the course of this discussion. I just want to really focus today on Yemen, because it's a place that is one of those crises that has a compounding effect much like what's going on in Lebanon right now with the economic collapse and with the pandemic. All the burden on the political life of the country. In Yemen in particular, we have a national health system that's already been pushed past the brink of collapse for years because of a devastating conflict of course.

As COVID-19 has come into it, we've had a spike in deaths in Yemen, our teams in Yemen are dealing with many, many challenges there from having access to COVID tests, personal protective equipment which has been a pressure point for many of our teams around the world, and of course inadequate hospital staffing and misinformation about the virus. All the things that could go wrong seemed to be going wrong but we are working with health colleagues from Yemen to make it so much better, so we're just going to really focus on that today.

Before I continue a couple of quick little notes about this webinar, we will go for around 45 minutes and wherever you're joining from today you can join with your questions you can ask them. If you're watching on Zoom send the questions through the Q&A, it's just there at the bottom of your screen. If you're joining us on YouTube live or Twitch you can send the questions into the comments section. We will prioritize of course questions related to the pandemic in Yemen. So joining me today we have three guests, Dr. Nizar Mohamed. He's an MSF anesthesiologist and an intensive care unit doctor in Yemen. We also have Dr. Diana Galindo Pineda, she's the medical team leader for MSF in Yemen and Ghassan Abou Chaar, deputy emergency desk manager for MSF and I'd like to say hello to all of you.

Are you all there? We'll just make sure that we have established contact. Ghassan maybe you could tell us, you're also keeping an eye on what's going on in Beirut, maybe you can just give us a quick overview of the kinds of things that we're trying to do to support the injured in Beirut today.

Ghassan Abou Chaar:

So first say that our teams in Beirut are doing fine. Directly after the blast or the explosion, a couple of hours after we have been able to take what we have in stock in terms of essential drugs that could be useful in the hospital that were overwhelmed with the wounded. So we distributed some of our stock and since then we have been going around in the different neighborhoods of Beirut doing assessment and looking at support we can do in terms of medical care for the people in the hospital and outside, but also other needs for the people who are displaced and left without homes and are staying in different areas from where they are originally. So we are sending drugs inside of the country and there's also an extra team that will join the teams in Beirut soon.

Avril Benoît:

Okay, it's really good to hear. It must be so difficult for them and we were heartened soon after the blast to hear that the MSF staff was all accounted for because that's one of the first things that you have to do is just say, "Where are your people? And is everyone okay?" And that's certainly something that we know what a close call it was for so many of them. Maybe I could just check in with you Diana, tell me where you are and what's on your mind today?

Dr. Diana Galindo Pineda:

So I am in Sana’a, I'm actually next to the Dr. Nizar and we're in the coordination office. It's raining so I hope that connection doesn't cut or anything. That's it.

Avril Benoît:

Okay, and how about you Nizar, how are you today?

Dr. Nizar Mohamed Jahlan:

I'm fine but as Dr. Diana says we're raining too much, it was so difficult to come to the coordination office. I'm now in the head of the patient office.

Avril Benoît:

Okay, and so what sort of impact is the does the rain then have on movements around the city?

Dr. Nizar Mohamed Jahlan:

It's so difficult. So a lot of streets, a lot of them it's broken and you cannot cross for several hours sometimes.

Dr. Diana Galindo Pineda:

Sorry, it's an issue for our staff to move but also for patients to move around, and pharmacy and everything is really difficult to move things around the city.

Dr. Nizar Mohamed Jahlan:

Mm-hmm.

Avril Benoît:

We are likely to have a little bit of a delay on the call but that's okay we'll just get used to it. Ghassan maybe you can just start by giving us a general overview of how COVID-19 has affected Yemen?

Ghassan Abou Chaar:

Well, COVID-19 arrived... and first of all we were very surprised that COVID-19 arrived to Yemen. Yemen has been since the beginning of the war in 2015 cut out somehow from the rest of the world, half of the country has some sort of an embargo on it where airports are closed, no commercial flights, ports are very heavily controlled and then in the south of the country there is not much going on, not much exchange, one plane per day maximum so we're very surprised that the virus arrived in the state. After four years, five years today of war the economic situation of the population is very difficult to do the day by day to be able to feed their families, to give to the babies good food, good milk what is really essential for the nutrition. On the same time the health system in the country is already we can say collapsed, is sort of surviving on cost recovery. Patients have to pay for emergency services and the rest on NGOs and hospitals like our hospitals that we run that are free of care for the population.

The COVID when it started it was a big shock for everyone. The Yemenis didn't believe it and I understand that, they didn't believe that exists so it went unnoticed. The Ministry of Health didn't have testing capacity so we were surprised directly by patients arriving on their last breath to our hospitals. So nobody was ready for it, at the beginning the first weeks were very, very difficult we had very high mortality. We knew first about the epidemic by counting tombs in the graveyard, we saw a big increase of death specially first in the city of Aden and then in the city of Sana’a. And surely, the hospital of the Ministry of Health couldn't cope with that and it's really a sad situation even before the COVID outbreak and this outbreak just made it much worse.

Avril Benoît:

I can imagine. Diana and Nizar you're both working at the Al-Kuwait hospital in Sana’a, can you describe Diana what it's like there at that hospital?

Dr. Diana Galindo Pineda:

We're working with the Ministry of Health, we have an ER that gets older patients we treat them. Some of them we discharge them home with just some advices about how to self-isolate and others that come in bad shape then we keep them rather in the IPD or the ICU, we have both services.

Avril Benoît:

Nizar is the ICU very busy where you’re working?

Dr. Nizar Mohamed Jahlan:

Actually, there is a big difference and between... since two to three months from the beginning of the pandemic and the crisis and on those days, the numbers decrease a little bit but also the risk factors decrease more than 50%. There was a huge number of mortality case in the ICU as it was all over the world, but now it's decreased a lot in comparison with the before.

Avril Benoît:

It's difficult though when you don't have access to testing, we have already a question that's come in from someone watching on Zoom and asking is there a real sense of the infection rate of COVID-19 in Yemen? Ghassan you mentioned in the beginning the best we could do was count newly dug graves. How are things now in terms of knowing who has it?

Ghassan Abou Chaar:

Just to give an example of what we have as numbers today, official numbers of COVID-19 cases officially declared by the Government of Yemen is around... I don't know the exact number but it's around 1700. In our two hospitals we have so far treated around 1200 and those are severe cases or very, very severe cases. We know that we don't cover the whole country we only cover two cities, we usually see from the numbers that only 5% require intensive care unit so where are the other 95%? They are today not officially declared. So we think we are only scratching the tip of the iceberg from what we see today.

Avril Benoît:

It must be so difficult to go out and run testing sites. Diana can you speak to that challenge?

Dr. Diana Galindo Pineda:

It's difficult because as I was saying even transportation can be a challenge, and there're shortages everywhere for tests. So Yemen is of course not an exception and it's even more difficult to get them properly done here. So we go a lot with clinics, we go a lot with some other tests, X-ray, CT scan that we can do in some cases but we trust a lot in the clinical sense of our physicians.

Avril Benoît:

Diana how much did this arrival of COVID-19 affect the other medical work that MSF was doing before the pandemic?

Dr. Diana Galindo Pineda:

So, as you were saying it's already a difficult situation sanitary speaking, and the fact that everything stops for all chronic diseases makes it even harder. So we are now seeing a lot of patients that have comorbidities that don't go to another internist anymore, that cannot have any proper control of cancer or hypertension or diabetes and this is young and also old people. So the base let's say it's already affected, and then COVID is just coming and making it... everything much more hard.

Avril Benoît:

One of the things that has been very difficult for many teams and many medical staff all over the world really has been some of the misinformation. Even in the United States I can tell you it's been absolutely appalling the level of misinformation that's been going around even from people who should know a lot better. Maybe Nizar you can tell us what it's like there, what sort of lies and falsehoods are spreading about COVID-19?

Dr. Nizar Mohamed Jahlan:

Because this is a crisis it was sudden and all over the world not just only in Yemen, and regarding the Yemeni people and the community they cannot believe this... we have a COVID-19 in Yemen. They denied it from our society, even from our communities they said we don't have COVID-19 and there was a lot of people dying at home and they don't know that they are getting the disease. Actually, we're receiving a lot of bodies because we have only one center for washing the cadavers and then shifting them to a specific place as guiding by Ministry of Health. So it was so difficult to get any numbers or any information from those people, till now we are still suffering from this issue.

Avril Benoît:

Well, there are a number of issues that I'm sure our audience is interested in asking you about. If you're watching on Zoom again you can send your questions into the Q&A and they will be passed along to me. If you're watching on YouTube Live or Twitch, just send the questions into the comments or the chat section and we'll find them there. Let's talk a little bit about supplies, Ghassan you mentioned the blockade, the difficulties of moving supplies in. Is there not a humanitarian sort of exception for medical people to be able to get what they need for this?

Ghassan Abou Chaar:

We do, we have been able to negotiate access in Yemen for humanitarian aid since after the war started in 2015. The system is very difficult, it's very cumbersome. It costs us a lot of money to be able to navigate it, however we are able to get it in. But the problem is that usually in countries where we work in, as Médecins Sans Frontières where there's a situation of war or there's something, we operate as medical staff, we work in hospitals and there are other hospitals nearby working. It's difficult to take charge of a whole population of 27 million as of Yemen. The problem is that other hospitals and pharmacies are not able to bring in medical supplies quickly and as easily as we can and it backfires on us because we are getting more. For example, what happened in Aden at the beginning of the epidemic is that the rest of the hospitals stopped working because they didn't have enough protective equipment.

So we were the only hospital working in the city and it's a trauma hospital, it's a traumatology hospital we were receiving all the cases. So, issues of supplies already were difficult around the world because the shortages of supplies related to this pandemic were very difficult to get in. We prioritized Yemen as an operation because we know that the country will not be able to get in other supplies rather than the humanitarian aid.

Avril Benoît:

You are watching a special webcast from Médecins Sans Frontières or MSF, Doctors Without Borders, and my guests today are Dr. Nizar Mohamed, an anesthesiologist and ICU doctor working in Yemen, Dr. Diana Galindo Pineda who is a medical team leader, and we also have Ghassan Abou Chaar who's the deputy emergency desk manager for MSF and we welcome your questions. I actually have a question, it's clear that you are the ones who are working in Yemen itself. You're working tirelessly around the clock even at the best of times before this pandemic. Well, there are no best of times because of the conflict. Diana how has the fighting which is sporadic affected the work that MSF does in this pandemic?

Dr. Diana Galindo Pineda:

So in Sana’a we have maybe a little bit less affection let's say, in the south it's definitely different. It depends on how far you are from the frontlines. It doesn't stop... the war doesn't stop and doesn't respect the pandemic, so we just have to cope with having both populations still in need of care.

Avril Benoît:

What effect is the staffing shortage having on our ability to deal with it?

Dr. Diana Galindo Pineda:

Sorry, can you repeat the question please?

Avril Benoît:

What effect has the lack of medical staff and the collapse of the health system also, what effect has that had on our ability to support efforts to address the pandemic in Yemen?

Dr. Diana Galindo Pineda:

That the quality of care will not be ideal and we will not be able to reach the same care that we would like to provide. We don't have the main, the ratio, necessary to treat the... for a certain number of patients we need a certain number of doctors and nurses, and so it's really hard to reach a good level of care and we're still struggling with it.

Avril Benoît:

Yeah, and Ghassan we are trying to work also in support of other organizations you have mentioned already the Ministry of Health, what sort of partnerships do we have in Yemen?

Ghassan Abou Chaar:

Well, most of the work we do in Yemen we try to do it with the local authorities which is the Ministry of Health that operates hospitals, referral hospitals or other that needs support so we come and support those centers. Usually, maternities or trauma centers or even just general hospitals are dealing with everything, and so most of the time we work with the Ministry of Health but we do it very closely with the centers themselves, especially smaller health clinics near the front lines that receive a lot of wounded population but also with a population around that is suffering a lot. So we have direct contact with those health centers and we support them directly with sometimes staff, sometimes drugs depending on each of them. So we do it a lot with health professionals, local health professionals are the ones we do it with and sometimes we do it alone depending on the setup and what is the easiest way to do it.

Avril Benoît:

Dr. Nizar I have a question for you about the intensive care units. There has been over the course of this pandemic of course a lot of new learning about intubation, oxygen, all the ways that you can support somebody in the ICU. What works, what works less well than we thought it would, what has been your experience in the ICU?

Dr. Nizar Mohamed Jahlan:

At the beginning actually we have a lot of challenges regarding this subject. When we are talking about the oxygen supply at the beginning we don't have a reservoir in the hospital, and we starting to receive the patient with... using manifold cylinders supplied by MSF, and we have big challenge also regarding the negative pressure vacuum system which is mandatory in the isolation ICU room in COVID ICU, and that's... At the beginning we have big challenges regarding the staff, health staff so they don't have any experience regarding those patients. So I was with them from the beginning and we were suffering a lot at the beginning, and I got an infection because of this difficulties of managing these patients.

Avril Benoît:

You got the infection yourself?

Dr. Nizar Mohamed Jahlan:

Yes.

Avril Benoît:

And how was it for you?

Dr. Nizar Mohamed Jahlan:

It was so difficult for me because I was afraid I transferred the infection for my wife and she's crying a lot and he told us he became a widow within days. Really, really, it was so difficult for me and for my family also but thanks God I come back and I resume my activity again inside the ICU and I'm still working till today.

Avril Benoît:

Yeah, it must have been so difficult. How has the infection rate been among medical staff, healthcare workers and even hospital staff?

Dr. Nizar Mohamed Jahlan:

Yeah, there was... because there was an epic shortage in our PPE, personal protective equipment at the beginning and most of them they don't have experience how to use it. We did some training courses but we cannot cover all the theme, all the health stuffs was covered by MSF at the beginning of... but later on we don't have the time to cover all of those medical health. So a lot of them they got an infection and we lost a lot of our friend, not in our projects but outside. In our project, there was the only about three to four doctors and nurses with the infection, I was one of them. Actually, it was very, very difficult then after I recovered I insist to come back to work because I know what's the patients suffering from it. So thanks God and I hope all rest patients in the ICU to be recovered as soon as possible.

Avril Benoît:

Yeah, and Diana how was it for you to manage that whole situation?

Dr. Diana Galindo Pineda:

So, to complete a little bit what Dr. Nizar was saying, I think in Yemen as in everywhere in the world there's a high peak of mortality at the very beginning and then it starts going down even if we still have a lot of patients. The teams learn how to... we learn from the other countries, so mortality has been decreasing and also we're having a little bit more of access about certain materials or medicines and even more staff that can come back to work with us.

So it hasn't been easy to see such high mortality rates I... it's the first time that I have so many deaths in a project and it's hard to have to deal with the logistics of dead bodies and huge amounts of oxygen and huge amounts of waste, and it's a whole different way of working that we have never seen before and that we're learning day by day. So it's been challenging but it's been very motivating and the team that we have is extremely motivated, it's very open to all of the trainings. Once again we don't know anything about everything because we're also just learning from what's happened, but we are lucky that we can get that motivation like put in a good way of working.

Avril Benoît:

Yeah, it's... what you're describing is the emotional and psychological toll that certainly doctors in other parts of the world where they were really facing full, full hospitals and that high mortality rate, the difficulty that they have to overcome it but then it's also people who are caring for those who have COVID-19 at home and the fear of all of that. We have a number of questions coming in from people who are watching us on Zoom and on YouTube and on Twitch and all of the rest. This is from Frederica, does COVID-19 also have an impact on cholera in the country? Maybe Diana you could take this one.

Dr. Diana Galindo Pineda:

So, cholera has been around in the country for a long time already. Dr. Nizar he also knows because we actually in Al-Kuwait we used to do already interventions for cholera. So it's something that comes back every now and then, we're crossing our fingers so it doesn't come back very soon because really it's not a good moment to have it. With the rains that are happening we will see how it evolves.

Avril Benoît:

A related question in terms of the specific vulnerability of Yemen is also the food insecurity. Ghassan this is something that we've been watching for many years, what kind of concerns do you have about how the food insecurity is affecting our ability to deal with the pandemic?

Ghassan Abou Chaar:

The food insecurity and malnutrition has been present in Yemen since many years, the effect of the war on it is that more people couldn't have enough purchasing power to be able to have enough resources. We see it in another way, we see it for example the effect on children who are malnourished even before they are six months old which is very strange. Usually, malnourishment are over six months and we see it because the mother is obliged to go to work and she cannot give her baby a formula milk so it has very strange impact. It's not just a shortage of food but it's how the people can access this food and what do they prioritize. For the moment people are still prioritizing buying food for their family, however they are taking from their economies, they are selling land, they are... so it's a very difficult situation if it continues like that it's not something that the people can resist, be more resilient, that the word I'm searching for.

Avril Benoît:

A related question from Kathy who asks it via Zoom, are there COVID cases being identified among children in Yemen as we see in the United States for example? Diana are you seeing children?

Dr. Diana Galindo Pineda:

We are lucky that we are not seeing many children and we're really lucky that it's not the case. We've had a couple of them not more than 10 I would say, but we are... it's not easy to watch them so we really hope that we don't get more.

Avril Benoît:

Yeah, it's difficult though as you described earlier with the lack of testing capacity around the country, and if the people are not so sick as to come to the hospital their chances of getting tested seemed quite limited. Just a follow up to that topic from Jake who's asking is there access to diagnostic testing in Yemen? So we covered this a little bit earlier but maybe Nizar you could speak to this. What is available to somebody who thinks they have it?

Dr. Nizar Mohamed Jahlan:

As we said we have shortages, there was a global shortage regarding the tests especially for the PCR for the COVID-19, but day by day we are dealing more on sample facilities that we have even when we don't have a CT scan inside our hospital. We didn't own the assemble chest X-ray and the skills of our doctors in the ER, in the IPD, in the ICU for the symptoms and the signs which day by day is improved, and still we are depending on it except some people who came from outside, from another private hospital they came by confirmed cases by the CT scan results, we depend on it too much and that's it.

Avril Benoît:

Yeah. We have a question here for you Nizar from Shruti Sharma.

Dr. Nizar Mohamed Jahlan:

Mm-hmm.

Avril Benoît:

What is the general mood of the people in Yemen in relation to the overall situation in the country? I mean we had talked about the cascading problems of the war and malnutrition and cholera, and it just seemed one thing after another and now this. So how are people doing?

Dr. Nizar Mohamed Jahlan:

Yes, a lot of crisis they are facing in our society in Yemen but as I told you the people they said and denied and they said we don't have COVID-19 in Yemen. Till today most of them they say we don't have a COVID so that's it... and a lot of suffering also from people regarding this... and that's it.

Avril Benoît:

We have a question here from Anushka. Are there violent threats for example bombings or attacks affecting MSF hospitals and operations in Yemen? Ghassan what do you know about the security environment as it affects our work?

Ghassan Abou Chaar:

Well, it depends on where we are. We had five of our health centers and hospitals have been bombarded during this war. We had even a death in our teams and our patients during those bombardments... aerial bombardments. This especially in the north of the country in areas where there is a lot of airstrikes, and still ongoing until today that's a very dangerous area to work in. In the south of the country navigating through different fighting due to war but also due to fights in families, and in neighborhoods is a different type of threat environment to work on and to navigate in. So it's... Today Yemen is one of the biggest operations for MSF due to all the medical needs, but it's also one of the dangerous that we are working in.

Avril Benoît:

A question here on Zoom from Borchueh Wu, are you seeing different outcomes in Aden or in Sanaa or is MSF operational response similar in both places? Ghassan what do you know of the difference that we're seeing in the both regions?

Ghassan Abou Chaar:

It's the same that we saw, the same result I would say from... in terms of mortality and in terms of what the patients are responding to. So in the two projects we are minimizing the use of invasive intubation and we are moving to use of non-invasive intubation and we see an improvement and the... and how the patients are responding to that, so mortality rates in our intensive care unit is improving. However, the only difference is that the curve in Aden was much shorter, it was much quicker while in Sanaa its staying. It's going down but in a very, very slow tempo and this curve is not the epidemic curve it's the curve of the patients that we receive in our hospital. So it's... this is how we are reading the epidemic for the moment.

Avril Benoît:

Yeah, and I'm sure there will be lots to analyze. I mean this has been a phenomenon with a novel virus like this how much you learn about what are the techniques that work better, but with people having better survival rates in the hospitals I have a question for you Diana from Katherine Brown. Are people afraid to go to hospitals or clinics because they might get sick inside the hospital and have worse outcomes for having gone? And if so what are MSF teams, what is Doctors Without Borders doing to encourage people to come and re-assure them that things will be handled in a safe way?

Dr. Diana Galindo Pineda:

So, we had sort of two phases of patient arrivals. The first one was at the very beginning of the epidemic, people were really afraid to come to the hospital. There were a lot of rumors, a lot of misconception so people didn't want to come in. They were arriving at a very, very late stage and now we're receiving a little bit more people that come maybe before, but then there's also some kind of denial. So it's just the... they think its just a regular respiratory infection. The caretakers they want to come in, they want to visit their families because they say coronavirus is over so it's very... it changes very fast. So we... Yeah, we faced those two those ways and now we're adapting to how to not make the other caretakers and the other people that are coming for other diseases, not to get infected because we don't want to give them nosocomial coronavirus.

Avril Benoît:

Peter is asking are people required to wear masks in Yemen? And if they are, are they wearing them? I guess not if people don't really believe it's a real thing. Diana?

Dr. Diana Galindo Pineda:

I think Dr. Nizar will be able to tell you about the outside world of the hospital. In the hospital its mandatory and we wear it all, but in the streets Dr. Nizar can tell us more.

Dr. Nizar Mohamed Jahlan:

Yes, humans in the community, Avril?

Avril Benoît:

Yes.

Dr. Nizar Mohamed Jahlan:

Yeah, they stopped even the social distance and wearing the mask outside. In our malls and markets it was a mandatory in the previous month to wearing them, you couldn't go inside the malls without a mask. Now it’s free, all of them they said we don't have more coronavirus and we are okay.

Avril Benoît:

You know what? I was watching the footage from Beirut and their first responders dealing with... trying to rescue people to get them out of harm's way, and looking at the pictures I was really struck by how many masks I was seeing in Beirut among those first responders. I mean not everyone, some of them were wearing under the chin and others are not wearing but it's clear that when you have the compounding effect of a catastrophe, or in the case of Yemen the crisis of bombing shelling and all the violence that can go with being in a conflict zone mixed with the pandemic it's just unfathomable. Ghassan maybe you can just... since we started with you in talking a little bit about the work that you're also managing for Beirut and the emergency response there. How you see this mix exacerbating the problems that we're likely to see in Beirut, just as an example of something that's very much on our minds.

Ghassan Abou Chaar:

I think the... I was... I'm Lebanese as well but I was surprised to see since the beginning of this pandemic and the cases in Lebanon that the people started wearing masks, I was thinking they will not wear it. There everyone was wearing it because they knew that the health system in Lebanon is weak already and in case the number of severe patients that need hospitalization go up very, very high we will just collapse. So, the people were wearing it out of fear of it, and now with this bomb that happened I agree with you I saw a lot of people still wearing them not the majority, but today it's changing again and the people are going back to taking care of that because the people are afraid of this mix of so many factors, the economy and the blast and the homelessness and yeah the health system will not be able to cope.

Avril Benoît:

Well, let's do a final round. We have many people asking how can they help? It's sometimes so overwhelming what's going on all around the world and when we really focus in on Beirut and on Yemen, it's sometimes also you just think, "My goodness, what can I do?" Ghassan what would be your message to those who would like to help?

Ghassan Abou Chaar:

I've been following Yemen since 2017. I've been there in 2017 and we see the number of donations going to the... not only to Médecins Sans Frontières but to the UN, to the whole humanitarian community is decreasing a lot and this year has decreased a lot, and without this humanitarian aid it would be very difficult for the population to keep going. Today there is no work, there is no income, there is no trade and the country is closed up. So for us it's... for us in Médecins Sans Frontières we are suffering with that, we are seeing other NGOs around us that used to be... we used to be working together filling gaps here and there, it's still not covering the whole country. Now we see them decreasing their projects and their support one by one and this year was really very... like a big decrease even with the COVID and the people are decreasing and we see less activities. We see health center that used to have malnutrition children are not supported anymore. Usually people who are likely given assistance is not receiving it anymore so we need this.

For us Médecins Sans Frontières, we also are suffering from this crisis to be able to find all the drugs and the supplies to send, and to have enough people to send and help as well. For us we need people, we need supplies to be able to continue working because Yemen is... as I said it's one of our biggest operation and it's very big, but there are other countries that are also starting to suffer from this pandemic so we are increasing everywhere. I think most importantly for me is not to forget that there is Yemen and this is happening there, and there is an ongoing war since now five years and it doesn't look like there's an end.

Avril Benoît:

Diana, what do you tell people who say, "I'd like to help, what can I do?"

Dr. Diana Galindo Pineda:

I would say wash your hands, take care of yourself and others, wear a face mask when required and fund us, we're really underfunded. I find myself comparing prices of antibiotics so that I give the cheapest one that is still good quality, and it's hard for me as a general physician to have to make these concessions or to have to think I'm going to use this instead of that because this is way too expensive and it's actually not that expensive.

Avril Benoît:

And finally Nizar, what can people do to help?

Dr. Nizar Mohamed Jahlan:

I advise everyone that we are not... and we are still in waiting for the second wave of COVID-19 we are not in safe sight till now, so everybody they should take care.

Avril Benoît:

Okay, we will and I really wish you lots of courage, and to the entire team working in Yemen thank you so much for all the efforts-

Dr. Nizar Mohamed Jahlan:

Thank you.

Avril Benoît:

Under very difficult circumstances and I really appreciate that all of you were able to take a bit of time off today to talk to us. It's been really a rich conversation and I wish you all the courage in the world to keep going. My guest today have been Dr. Nizar Mohamed, MSF anesthesiologist and an ICU doctor in Yemen. Dr. Diana Galindo Pineda, medical team leader for MSF in Yemen and Ghassan Abou Chaar deputy emergency desk manager for us. Thank you all and thanks to you if you are watching thanks for joining us, I really appreciate all these really good questions. Apologies if we didn't get to your question today, we'll be back with another of these Let's Talk COVID episodes in a few weeks. We're going to focus on disinformation next time, this whole question of the falsehoods and how it makes life so much more difficult for all the health workers who are doing their best to keep people safe, and get us through the worst of this.

So for more information on all of this you can check out updates on our website about our work in Yemen, about our work in Beirut, about our work in all the crisis zones emergency situations around the world where Doctors Without Borders has activities. In the US our website is doctorswithoutborders.org, internationally it's msf.org. We have a number of Facebook sites in English it's msf.english, on Twitter you can find us @MSF_USA and on Instagram we are also all over it. So for more specific questions that you might have please don't hesitate to contact us we would love to hear from you. We have an email address called event.rsvp@newyork.msf.org. I'm Avril Benoit signing off and thanks again for tuning in. Bye for now.