Yemen crisis update: August 2023

Access to health care

Blockaded roads and financial barriers often prevent people from accessing health care in a timely manner. The fuel crisis, inflation, high cost of transportation, and poor living conditions also make it difficult to access care, particularly for vulnerable families. The vast majority of people do not have regular incomes and struggle to meet their basic needs. 

The health system in Yemen has almost collapsed. According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), only 51 percent of health facilities are considered fully functional. Most health facilities lack staff (a workforce that is often not paid at all, or only irregularly), functioning equipment, and basic medicine supplies, especially in remote rural areas.  

At the primary health care level, the system suffers from many gaps, both in terms of available services and the quality of care provided. The impact has been devastating for patients as well as the hospitals MSF runs or supports, which are overwhelmed with patients who should be able to receive treatment at the primary care level, and patients presenting with acute medical conditions or complications that could have been avoided with proper primary care.  

People with chronic diseases like kidney failure and cancer struggle to survive in public hospitals with a lack of medications, and most can’t afford the cost of traveling abroad to get the required treatment. This puts already-vulnerable people, such as internally displaced people and migrants, at even greater risk.

Starting January 2023, the United Nations health cluster decided to cut its provision of incentives, including pay, for health workers in Yemen by 60 percent due to a decrease in funding for the country. This decision will affect the capacity of health structures to retain their staff, and the availability of specialized staff working in remote areas. The impact has been felt in MSF facilities, which are becoming the only places people can access free-of-charge health care in the country. 

Gaps in primary health care

MSF-supported emergency rooms receive many patients who do not meet admission criteria but prefer coming to the hospital instead of primary health care centers closer to where they live. In addition, the limited availability of quality services at the primary health care level affects the severity of cases we receive. 

In 2022, the admission rate in the pediatric and neonatal units in Ad Dahi Hospital in Al-Hudayda increased by 65 percent and we doubled the capacity of the wards from 20 to 40 beds. And in Taiz Houban, we had to redirect over 9,000 uncomplicated cases to primary health care facilities.  

Malnutrition

Malnutrition is a persistent risk to children in Yemen. The country sees seasonal and annual peaks, usually linked to the lean season caused by the disruption of agricultural production in rural areas. This pattern was seen before the escalation of the war in late 2014, but has since worsened due to the ongoing conflict, which has exacerbated food insecurity for already vulnerable people.

There are many underlying causes for malnutrition in Yemen that extend beyond just food insecurity. Many families in Yemen can’t afford enough nutritious food. The country’s deepening economic crisis has caused prices to soar. Many people do not have access to paid work or have lost their homes due to the war. The cost of food and transportation, including fuel, are rising, which further impedes people’s access to sufficient food.

There is also great need to increase access to information for prenatal care and postnatal care, which are directly linked to preventing malnutrition. Moreover, there is limited awareness in the community about the importance of breastfeeding and routine vaccinations for children. Parents also don’t have access to information about identifying the initial symptoms of malnutrition, which delays its detection. 

MSF does not have a countrywide overview of people’s nutritional status in Yemen as we are not present in all of its 21 governorates, and no large-scale nutritional surveys have been conducted. However, in several of the governorates where we are currently running projects, we are witnessing a concerning increase in the number of malnourished children with medical complications in our facilities.  

With the early onset of the malnutrition peak in 2022, high admissions overwhelmed our facilities and necessitated emergency intervention in some locations to manage the surge in acute malnutrition cases and related health complications. In Khamir, Amran governorate, our team noted a 65 percent increase in admissions in 2023 compared to the same period in 2022. 

Malnutrition will continue to be an issue of concern in Yemen, as it causes preventable deaths, particularly for children under five years old. Health authorities, humanitarian organizations, and other health actors must work on a comprehensive response that aims to reinforce the scope and efficiency of nutritional surveillance countrywide, to improve data analysis, and to address gaps in primary health care facilities in order to anticipate and prevent peaks of malnutrition. It is also important to help build community health awareness to detect the early signs of malnutrition cases. 

Vaccine-preventable diseases

One of Yemen’s fastest-growing problems is that there have been multiple outbreaks of vaccine-preventable diseases. The country recorded more than 22,000 measles cases in 2022, including 161 deaths. In 2023 to date, cases have already spiked to 9,418, with 77 children dead.

Cases of tetanus, diphtheria, and pertussis, or whooping cough, are also on the rise, as are deaths from each disease. Moreover, the lack of immunization has had a major negative socio-economic impact on households, which face unaffordable hospitalization costs. With the rapid decline in immunization coverage, an atypically high mortality rate is expected to increase, especially if malnutrition rates continue to rise.  

Our teams in Yemen are responding to the increase in measles cases across several governorates (Saada, Amran, Hodeida, Hajjah, Al Bayda, Ibb, Taiz, and Shabwa) by opening new isolation units, extending bed capacity in isolation wards, and supporting case management in health facilities at primary and secondary levels as well as through mobile clinics. In the Ministry of Health’s Al Thawra Hospital in Al-Hudaydah City, MSF is supporting an isolation unit for measles case management. Of 306 suspected measles cases received from mid-July to November last year, 85 patients (35 percent) presented with acute malnutrition. Of all measles patients, only 15 percent had received a measles-containing vaccine before their admission, indicating the low vaccination coverage.

While measles cases continue to increase, many cases are still under-reported. Other massive challenges include the anti-vaccination narrative in the north of the country, no possibility for health actors to run vaccination campaigns, restrictions in the supply and transport of vaccines to remote areas, lack of health awareness, and poor primary health care services. The situation is putting millions of children in danger. 

MSF is calling on the Ministry of Health and other authorities, international donors, and the humanitarian and development communities to improve routine vaccinations at the primary health care level in order to avoid the emergence of preventable diseases. This should be supported by a scale-up in vaccination activities across governorates, especially targeting children under five who remain the most vulnerable. Activities must also include awareness-raising messages to tackle the negative perception of vaccination within communities. 

Mother and child care

As is the case in most countries, women and children are among the most vulnerable groups of the population. This vulnerability has been exacerbated during the war. After nine years of conflict, in most governorates where MSF works in Yemen, there is an ever-increasing demand for maternal and child health care, which is one of the main components of our operations in the country. In 2022, we assisted more than 184,730 births, compared to 31,973 in 2021. 

Many mothers, children, and newborns die upon arrival at hospitals, including those we run or support. Factors contributing to the high death rates mostly relate to the war. They include an insufficient number of functioning health facilities and their inaccessibility due to insecurity. 

Women and children are also the most affected among people with chronic diseases. In Al-Qanawis Mother and Child Hospital in Al-Hudayda governorate, our team noted that there were complications in more than 17 percent of all deliveries in the year. 

One of the main reasons is a lack of accessible prenatal care at the primary health care level to diagnose, treat, or refer patients. For instance, almost 40 percent of mothers admitted to the hospital come with anemia, which is a condition that can increase the risk of complications for the mother and the baby.  It can be treated with simple prenatal care if detected in time. 

Pregnant women living in rural areas often come to the hospital with high-risk or complicated pregnancies stemming from a lack of consistent prenatal and postnatal monitoring, either due to the absence of services or necessary medical specialities and basic equipment, like ultrasound machines, to perform them. At MSF's Mother and Child Hospital in Taiz Houban, complicated pregnancies constitute the larger part of patient cases we receive in the hospital. 

From August 2021 to August 2022, MSF’s team in Al-Jumhouri Hospital in Taiz governorate assisted 6,739 deliveries, out of which 4,184 were normal deliveries. Almost 29 percent required Caesarean sections—an indication of the high number of complex pregnancies arriving at the hospital.  

Mental health

Long years of war have resulted in the destruction of homes, loss of lives, displacement of thousands of people, and deterioration of economic and living conditions. All of these factors have taken a heavy toll on the mental health of people in Yemen, and many also struggle with family issues and traumas. The conflict and lack of access to mental health services has significantly impacted patients already suffering from chronic mental health disorders before the onset of the war.  

Our teams in Yemen provide mental health and psychosocial support through group sessions and individual consultations. MSF’s mental health care aims primarily to reduce people’s symptoms and improve their ability to manage difficult times so they can get on with their lives. 

In 2021, three primary health care centers run by MSF in Marib governorate introduced psychosocial support as a key component of medical services and have since become the sole providers of mental health care in the area.  

In Al-Gomhouri Hospital in Hajjah City, northwestern Yemen, our teams provide a holistic mental health program in collaboration with the Ministry of Health. We receive patients suffering from various mental health disorders with mild to severe symptoms, including anxiety, depressive episodes, post-traumatic stress disorder (PTSD), and behavioral problems. However, most patients arrive with severe conditions such as major depression, psychosis, and bipolar disorder, which require psychiatric treatment in addition to psychological care. These cases amount to 70 to 80 percent of our patients. 

People on the move

The years of conflict have particularly impacted internally displaced people (IDPs) who have fled multiple violent attacks. (More data on displacement here). As we respond to the needs of IDPs as well as non-displaced people in need, we have been receiving an increasing number of patients, especially children, suffering from diseases related to poor sanitation and harsh living conditions. We are also observing the consequences of people’s challenging living conditions on their physical and psychological well-being.   

Despite the ongoing conflict, Yemen hosts 137,000 refugees and asylum seekers from Somalia and Ethiopia, making it the world’s second-largest host of Somali refugees, according to the UN Refugee Agency. Additionally, many migrants have been stranded in areas like Al Jawf, Marib, and on the road to Aden, while traveling to Saudi Arabia in search of better living conditions. Migrants face desperate situations, often living in deplorable conditions with very poor access to basic services and are exposed to danger, abuse, and exploitation.  

To address some of these needs and ensure people in vulnerable situations are not excluded from medical care, MSF provides primary health care services to migrants from the Horn of Africa, as well as IDPs and a minority group known as Al Muhamasheen, or “the marginalized”—who are usually of African descent and suffer discrimination, poverty, and social exclusion. 

Emergency response

MSF teams are delivering emergency medical aid in Sana’a, Sa’ada, Taiz, Amran, Aden, Al-Dhale’, and Hajjah governorates. Activities include surgical care for the wounded, health care services in hospitals, support and medical supplies for local hospitals, mobile clinics, and the distribution of relief items to displaced people.