Yemen: Responding to an alarming rise in child malnutrition at Abs hospital

“The situation is worsening with every passing day”

Pediatric healthcare in Abs Hospital

Yemen 2020 © Nuha Haider/MSF

Malnutrition in Yemen is a complex health care issue that predates the beginning of the country’s current conflict. But, as new data from Doctors Without Borders/Médecins Sans Frontières (MSF) shows, the direct and indirect effects of the nearly seven-year-long war has exacerbated this deadly illness in northwestern Yemen’s Hajjah governorate and its surrounding areas, fueling an alarming rise in cases among children under five years old in 2021.

“[The] conflict has badly affected the country’s economy and weakened an already fragile health care system,” said Nicholas Papachrysostomou, MSF head of mission in Yemen. “The situation is worsening with every passing day.”

The MSF-supported inpatient therapeutic feeding center (ITFC) in Abs Hospital in Hajjah governorate—one of Yemen’s biggest facilities for the treatment of malnourished children—has been running at more than 100 percent capacity since the beginning of 2021. A total of 3,377 patients were admitted between January and November 2021, while teams received 76 percent more children with severe malnutrition coupled with medical complications—mainly respiratory tract infections and acute diarrhea—compared to the same period last year.

Most concerning for medical staff are the children who return to the ITFC. These children deteriorated again after already having been treated, often because they have not been able to access follow-up care or enough food regularly, leaving them trapped in a vicious cycle of malnutrition and recovery. However, the cause of malnutrition in children isn’t just a simple lack of food.

“Malnutrition in Yemen has been, at times, attributed to famine, which gives the impression that the country doesn’t have enough food for its population,” Papachrysostomou said. “But the issue of malnutrition here is more complex than a simple scarcity of food. Our concern is that, in fact, people may not be able to afford to buy food that otherwise exists.”

Many Yemenis are either unpaid for their work or have lost their livelihoods due to the conflict. On top of this, the depreciation of the Yemeni currency coupled with high prices of food, fuel, and other necessities has eroded people’s buying power. Abs and surrounding areas currently host approximately 55,650 households displaced due to the conflict—most of which rely on humanitarian aid for survival. As a result, many families struggle to afford the right quantity and nutritional quality of food for their children.

Medics in the ITFC at Abs Hospital observed that out of all malnourished children admitted in 2021, around 33 percent are between one and six months old. An almost non-existent primary health care system has made access to care very difficult, if not impossible, for many pregnant people, parents, and newborn children. An undernourished person is more likely to give birth to an underweight child, which leaves some children vulnerable to malnutrition from the day they’re born. Low rates of breastfeeding further aggravate the situation.

Many of the severely malnourished children MSF cares for can be treated at an outpatient facility without requiring hospitalization. However, many people—especially in more remote areas—live too far away from these facilities to make use of them. Consequently, the condition of a child with moderate malnutrition that remains untreated for too long can deteriorate to the point of requiring hospitalization.

“Due to a very weak system of primary health care services in Hajjah governorate, patients often travel long distances and arrive in a critical condition at our facility in Abs Hospital,” Papachrysostomou said. “Humanitarian groups must prioritize mother and child health care, as well as support the health care system to make primary health care services more functional. An improved primary health care system can help mothers and children receive care at an early stage to prevent a health care condition becoming more severe.”

While access to medical care is critical for many children with malnutrition, responding to people’s basic needs is the best way to truly address and prevent this illness from happening in the first place. This can be done by expanding food distribution in areas badly affected by malnutrition and increasing community awareness of good hygiene practices and the benefits of breastfeeding, as well as the early identification of malnutrition symptoms. MSF currently has a team of community health care workers in and around Abs working in the camps for internally displaced people that conduct screenings, identify malnourished children, and refer them to centers for treatment.

At the same time, the financial situation of people affected by the conflict needs to be addressed through economic and infrastructural change as well as livelihood support. Most importantly, the warring parties must ensure that the cost of war does not fall on those least able to bear it. Without these changes, malnutrition cases among children under five are likely to continue rising both in number and severity.