Propping Up Yemen’s Health System Without Pay

Saving lives without salaries in Yemen

YEMEN 2017 © Florian SERIEX/MSF

Dozens of staff in the emergency room of Yemen’s Al Kuwait hospital continue to work without pay. The hospital is the only public structure in the capital, Sana’a, providing services free of charge. Most of the staff have not received their regular salaries from the Ministry of Public Health and Population in over a year, and are unable to cover their needs.

Doctors Without Borders/Médecins Sans Frontières (MSF) provides stipends and other incentives to help retain key staff, however much greater support is needed from Yemeni authorities and the international community to prevent the collapse of the public health system.  

Read: Government Health Staff are Saving Lives Without Salaries in War-Torn Country

These people are doctors, midwifes, and nurses, and, despite the lack of payment, they remain committed to their patients and continue to work. But every day they spend in the hospital comes with a new set of questions: Will they have money to pay for transportation tomorrow? What will happen if a member of the family falls sick? Will they be forced to sell more of their jewelry to buy food?

The questions and sorrows they shared with MSF are a terrible reflection of the deterioration of Yemen’s health system. The international community must urgently intervene to help pay the salaries of public health workers to sustain their efforts to provide lifesaving care.  

Australia, a midwife, began working at Al Kuwait hospital in 2009.

“Until September 2016, I earned 38,000 Yemeni dollars, the equivalent of 100 US dollars. That was the last time I received a salary. Since then, I haven’t been paid. Some days I have to walk to the hospital because I don’t have enough money for transport. My work hasn’t changed at all, except now I do it for free. I feel really bitter, but there’s nothing we can do. We went on strike for a few days, but we returned to our jobs. My family used to give me money from time to time, but they also work in the public sector and face the same cuts. One of my brothers was a pilot before the war. Now he works in an abaya [clothing] shop. It’s sad to see what has become of us.”

Kawkab started working in Al Kuwait a year ago, but hasn’t received a salary since then. Like most of her colleagues, she keeps working in the hope that better days will come. She runs from one patient to another, making sure everything is in order. Catching her breath, she stares into the emergency room.

“I was so happy when I accomplished this step [to join the public health system]. We Yemenis seek jobs as civil servants because we believe it’s more secure.… On weekends, I buy khat [a plant used as a mild stimulant] at the market and try to sell it. We live off what I earn from that, and I try to save some money to pay for my transport to the hospital. When I don’t have enough, I walk to the hospital despite the long distance. I hope we’ll receive our salaries so we can live like other human beings. This situation has distressed us, but there’s nothing we can do.”

Dr. Ameen Al Gunaid does not have an enviable position at the moment. As the director of Al Kuwait hospital, he understands his responsibility towards his team. For him, there’s only one thing that matters: the hospital needs to keep providing medical services, whatever the costs.

“It was a shock for the staff when we announced they would not be paid. They went on strike, but we cooled things down, promising them they would get their salaries. During the first two months, the impact was limited because most of the staff had enough savings to deal with the situation. But Al Kuwait isn’t a private hospital; it provides free care to patients, so it’s not sustainable like other [facilities]. It means we don’t have the financial capacity to give our staff salaries. On the other hand, Al Kuwait is a teaching hospital hosting many university students who come and work as part of their studies. This, in addition to the support MSF has given to some departments, is the main reason why the hospital didn’t face a staff shortage.”

“A few months after we stopped paying salaries, some of our staff began to take unpaid leave and returned to their villages. Others kept working with the hope of getting back their salaries and out of fear of losing their jobs. The lucky ones were the consultant doctors who found jobs in private hospitals. Many of them remain committed to Al Kuwait and keep coming to the hospital in their spare time to provide services to citizens who can’t afford treatment in a private hospital.”

Dr. Al Gunaid and his team try to find solutions for staff who can no longer pay for accommodation or transportation.

“Before the war, we had more than 150 nurses from India [accommodated inside the hospital], but they returned to their country…. We reallocated the space to our Yemeni staff. We also provide them with a meal every day to help them under these circumstances.”

The situation remains tense. Dr. Al Gunaid understands the difficulties faced by hospital staff but has few solutions. Following the massive cholera outbreak in the country, MSF opened a cholera treatment center in the hospital which now employs some of the staff, providing them with income. But this situation will eventually come to an end and the question will remain: what can be done to keep Sana’a’s main public hospital running?