Yemen: Women and children die as war limits access to medical care

Pregnant women, newborns, and children are increasingly reaching medical facilities too late

Three-year-old Hassan, suffering from anemia and malnutrition, plays with his aunt inside the therapeutic feeding center, at MSF's Taiz Houban Mother and Child Hospital. Hassan’s mother is sick at home with post-traumatic stress disorder, after she lost another baby.
Yemen 2018 © Matteo Bastianelli
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AMSTERDAM/BARCELONA/NEW YORK, April 24, 2019—The war in Yemen is preventing women and children from receiving lifesaving medical care on time, contributing to an increasing number of deaths, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) said today in a report, Complicated Delivery.

Pregnant women, newborns, and children—among the most vulnerable people in Yemeni society—are increasingly reaching medical facilities too late. At MSF's Taiz Houban Mother and Child Hospital, the number of children and newborns dead on arrival has increased from 52 in 2016 to 72 in 2017 to 103 in 2018. The most common causes of death among newborns were prematurity, birth asphyxia, and severe infections.

"Last month in our emergency room we had 10 cases of children arriving dead," said Rachel Fletcher, MSF's Taiz Houban hospital manager. "Of those 10 deaths, four were clearly the result of traveling for several days to get here. If they had lived closer to MSF's hospital or had had the ability to pay for transport or medicines to treat a simple chest infection, it would not have resulted in such a serious outcome."

The report focuses on mothers and children in two hospitals where MSF works in war-torn areas: the Houban suburb of Taiz city (Taiz Houban), and the district of Abs in Hajjah governorate. After more than four years of war, an economic crisis has made treatment unaffordable, many hospitals are not functioning, and patients must travel through conflict zones to reach care.

Before the escalation of the conflict in 2015, Taiz city, with about 615,000 people, had five public hospitals. As of March 2019, no public hospital in Taiz city or the surrounding governorate was fully functioning. Three of the hospitals in central Taiz city remain partially open, with support from MSF and other international aid organizations. However, these hospitals do not provide the same level of services as before and are not easily accessible.

Across Yemen, many patients now have to cross front lines, pass through no-man’s land or negotiate their way through multiple checkpoints to reach a functioning hospital. In Houban, what was once a 10-minute journey to a hospital in central Taiz can now take six hours, as patients must travel around an active front line. In Abs, patients are sometimes prevented from traveling because of airstrikes and clashes.

Medical staff face the same challenges accessing hospitals as their patients. Only this week, another MSF-supported hospital in Taiz city was forced to temporarily suspend its activities because of renewed heavy clashes. The violence resulted in the shutdown of the only remaining public hospital in the area providing maternal health care and is now blocking medical humanitarian staff from traveling to and from the hospital.

Traditionally, women in Yemen have given birth at home with the assistance of birth attendants, rather than in a hospital. When complications occurred, access to care was a much simpler process before the outbreak of the conflict. But now, medical complications during pregnancy have become much more dangerous.

At MSF's Taiz Houban hospital, 70 percent of arriving women suffer from life-threatening complications such as obstructed labor, prolonged labor, eclampsia, uterine rupture or post-partum bleeding. Without community-based health clinics providing prenatal care, complicated pregnancies go undiscovered until it is time to give birth.

"Primary health care services are not fully functioning and have not been in a long time," Fletcher said. "More often than not they are not staffed by health care professionals and, if they are, the staff are not usually trained in the management of the cases presented. Without sufficient capacity or trust in these services within the community, women are waiting until the last minute to make the dangerous journey to receive care."

In MSF's facilities in Taiz Houban and Abs, a total of 36 women died due to complications in childbirth from 2016 to 2018.

MSF calls on all warring parties to ensure the protection of health workers and other civilians, to allow the wounded and sick access to care and to ease restrictions on humanitarian organizations. MSF also calls on international aid organizations to scale up their humanitarian response, increasing the number of experienced staff in areas where the needs are greatest, and ensuring the supervision, quality and timeliness of aid.

MSF has scaled up its work in Yemen since the conflict escalated in 2015. Today, MSF runs 12 hospitals and health centers across the country and provides support to more than 20 hospitals or health facilities across 11 governorates: Abyan, Aden, Amran, Hajjah, Hodeidah, Ibb, Lahj, Saada, Sana'a, Shabwah, and Taiz. From March 2015 to December 2018, MSF teams performed 81,102 surgical interventions in the country, provided treatment to 119,113 patients with injuries related to war and violence, delivered 68,702 newborns, and cared for more than 116,687 patients with suspected cholera. As of 2019, MSF has 2,200 international and locally hired staff in Yemen and provides incentive payments to 700 Ministry of Health staff across the country