The Risky Search For Medical Care in War-Torn Yemen

War has once again escalated in Yemen. The April ceasefire agreement came to a violent end with suspension of peace talks on August 6. From northern Saada Governorate to Taiz Governorate in the south, intense airstrikes have resumed. Consequently, a Doctors Without Borders/Médecins Sans Frontières (MSF) hospital in the northern city of Abs was hit by a Saudi-led coalition airstrike on August 15. The damage of this attack is substantial: 19 were killed and 24 injured. Following this, MSF evacuated personnel from six MSF-supported hospitals in northern Yemen, where civilian casualties from airstrikes have been most intense, for security reasons.

“We talk about this airstrike because MSF was present in this hospital, and this is now the fourth MSF facility that has been attacked in the last 12 months,” said Hassan Bouceninem MSF head of mission in Yemen. “But there are other health centers, schools, markets, bridges . . . [that] have been attacked and destroyed by airstrikes, shelling, or bombs. Such attacks create direct victims but the war (economic failure, access problems, closing of hospitals, no health staff etc.) also causes a lot of indirect victims within the population.”

Hidden Casualties

The indirect victims of conflict are numerous. They might include a patient requiring a blood transfusion, or a woman requiring an emergency Caesarean section who are both unable to find a medical facility for treatment. Even where a medical facility is functioning, it will likely lack the capacity to provide medical care due to shortages of key supplies, personnel, or medicine, or have no fuel to run the generator. Some health facilities are simply too dangerous to reach so people have to make do without. On top of that, the war has caused Yemen’s economy to all but collapse, leaving many people with little or no income. Many have to choose between buying medicine or food for their families.

“Now that the violence has resumed, traveling to seek care is life-threatening,” says Laurent Sury, MSF head of emergency programs. Consequently, in the city of Haydan, located in Yemen’s northern Saada Governorate, people are not traveling for health care, MSF’s team has found.

In July, Haydan’s hospital was operating at full capacity. The MSF team provided 60 to 80 daily consultations. “Since the beginning of August, people are not traveling for care because they are afraid of using roads or they fear the hospital will be targeted,” said Sury, though the trip may be risked for emergencies, as was the case on August 13. Two days before the Abs hospital airstrike, the MSF team at the Haydan hospital admitted 38 injured children wounded in an aerial attack on what witnesses described as a Koranic school. Ten children were dead upon arrival, and 28 others were stabilized before being transferred to the MSF-supported Al Jumhori hospital in Saada.

This same hospital in Haydan was partially destroyed by a coalition-led air strike in October 2015. The ceasefire agreement enacted in April allowed the MSF team to return and rehabilitate the maternity ward and emergency room. Internally displaced people returned; children and pregnant women sought consultations. However, with insecurity now rife, residents are seeking shelter in caves during the day, and accessing medical care is very difficult.

In the south of Yemen, the situation is critical. In the besieged frontline city of Taiz, active fighting occurs in the densely populated city center where both the Houthi and the armed groups supported by the Aden government are engaged in heavy battles in densely populated residential neighborhoods on a daily basis. On August 18 and 19 August, 129 wounded were admitted in MSF supported hospitals alone. Inhabitants of the besieged part of the city struggle for food and water.

MSF provides support to four hospitals, but access to care is limited because of security concerns. On December 2, 2015, a Saudi-led coalition airstrike hit an MSF tent clinic in Taiz, resulting in nine wounded and one dead. On October 3, the MSF-supported Al Thawrah hospital was hit by rockets launched by the Houthis, injuring seven medical staff working in the emergency room.

With airstrikes, front line combat, and attacks like the August 29 suicide bombing in Aden, violence has fully resumed in Yemen. The population had only a few months of limited respite, and now the conflict continues to claim yet more direct and indirect victims. 

Abs hospital, in Hajjah governorate, northwestern Yemen, was hit by an airstrike in the afternoon of August 15 at 3.45pm local time, killing at least 14 people and injuring at least 19. The blast immediately killed nine people, including an MSF staff member. Two patients died while being transferred to Al Jamhouri hospital. Five patients remain hospitalised. Abs hospital, supported by MSF since July 2015, was partially destroyed. All remaining patients and staff have been evacuated. The location of the hospital was well known, and the hospital’s GPS coordinates were repeatedly shared with all parties to the conflict, including the Saudi-led coalition.