The Human Toll of Yemen’s Unending War

With the country’s health services decimated by conflict, cholera is raging through the civilian population.

by Alexandre Faite; Photographs by Ralph El Hage/International Committee of the Red Cross

Top photo: Hospital staff at Al Thawra public hospital in Hodeida treat patients in the overcrowded children’s ward. Two years of war has brought Yemen’s health system to the verge of collapse.

July 20, 2017

TAIZ, Yemen — This southwestern Yemeni city has been battered for more than two years of urban battles. When I arrived there in March, the journey from the city’s outskirts to its center should have taken only 10 minutes; instead, it took us four hours, as we wound our way through mountainous roads and dozens of checkpoints manned by teenagers with AK-47 assault rifles.

Crowds of people cheered us on as our Land Cruisers navigated trash, burned-out cars, and rubble after passing through the last checkpoint. It felt oddly like being a rock star, except I was entering a city embroiled in armed conflict instead of a concert hall.

Yemen is one of the poorest countries in the Middle East; since early 2015, its people have been caught up in fighting between forces loyal to the internationally recognized government of President Abed Rabbo Mansour Hadi and members of an armed group known as the Houthis. A Saudi-led coalition of mostly Arab states, which has received logistical and intelligence support from France, Britain, and the United States, has also been carrying out airstrikes against the Houthis since 2015 and has blockaded the import of supplies into the country.

My organization — the International Committee of the Red Cross (ICRC) — is one of the few aid agencies able to work inside the front-line city of Taiz. People living there knew that we came to bring relief. I had heard anecdotes, but what I saw in Taiz was more shocking than I imagined. Civilians dodge sniper fire as they walk down the street. Mortar shells frequently land on hospitals, schools, and homes. Doctors and nurses perform war surgeries without even the basic essentials. People scavenge for food in trash piles.

The battle line runs directly through Taiz’s city center, which has turned a significant part of the city into a “no-go” area for civilians. Fearful of sniper fire, our drivers sped through the bombed-out streets. We got within 300 yards of the front line, and it was a ghost town.

Many people in Taiz are hungry and sick, because there is not enough food or medicine. Most civilians live in constant fear. This is the urban suffering that we see in cities at war across the Middle East — from Taiz to Aleppo in Syria.

Taiz is a microcosm of Yemen’s war. More than two years of intense urban fighting have left at least 10,000 people dead across the country and laid waste to many of Yemen’s population centers. Airstrikes and artillery have decimated essential infrastructure: hospitals, water pipelines, electricity grids. Yemen historically relied on imports for 90 percent of its food. But severe restrictions on those imports — food, medicine, and fuel — have led to shortages across the country.

It’s no surprise that Yemen is on the verge of famine, and local doctors are struggling to stop the cholera epidemic sweeping the country. As of mid-July, more than 1,790 people have died from the disease countrywide, and another 350,000 are suspected of being infected. That means approximately 1 in every 90 Yemenis is believed to have cholera, a potentially fatal bacterial disease of the small intestine that causes severe vomiting and diarrhea.

As of mid-July, more than 1,790 people have died from the disease countrywide, and another 350,000 are suspected of being infected. That means approximately 1 in every 90 Yemenis is believed to have cholera.

The capital of Sanaa, the Red Sea port city of Hodeida, and Taiz are among the areas most affected by the outbreak. ICRC delegates have witnessed doctors and nurses, who haven’t been paid in 10 months, working around the clock to save lives at cholera treatment centers. We have watched exhausted mothers and fathers carrying their listless children to overcrowded health facilities in search of treatment. If there are no available beds, they sleep under those already filled.

The economic crisis triggered by the war has made matters worse. Inflation has pushed the price of food, medicine, and other essentials so high that people can no longer afford them. The Yemeni authorities’ inability to pay government salaries since last summer has led to a sharp deterioration of critical public services, compounding Yemen’s already desperate humanitarian crisis.

The public electric grid provides no electricity; as a result, local generators power the country’s water-pumping stations. Garbage has piled up in Yemen’s cities. The sewer system in Sanaa quit working on April 17, and cholera broke out 10 days later, spreading like wildfire. The outbreak has pushed Yemen’s health system to the brink of collapse.

In Taiz, almost every health center has shuttered its doors. Only two hospitals remain open, operating with a skeleton staff, burdened by frequent power cuts, a lack of supplies, and the occasional mortar shell explosion nearby.

The ICRC has doubled its budget for Yemen — but the extra resources are still only a tiny fraction of what’s needed. Most of the budget increase is dedicated to bolstering our medical response: We have already deployed a surgical team to Hodeida, and another will soon deploy to Aden. We are also providing support to 17 hospitals and health clinics across the country. The problem is that cholera is spreading faster than the response. Our field presence only enables us to care for 1 in 5 people affected by cholera.

Managing the fallout of Yemen’s proliferating crises requires more than humanitarian relief. Those fighting Yemen’s war must respect and protect civilians and take constant care to spare essential infrastructure. All states, but particularly those with ties to the belligerents, must use their influence to ensure parties to the conflict respect the rules of war.

A solution should also be found for Yemen’s public services. Hospitals, water systems, and trash services can’t function without budgets. The U.N. recently stepped up, offering to pay the salaries of doctors and health workers, but many other public servants remain unpaid. A solution to this dilemma must be found, or suffering will increase as public services grind to a complete halt across the country.

The dire situation in Taiz is just one example of how this brutal war is victimizing Yemen’s civilian population. It can take months to get humanitarian supplies to their destination. Humanitarian convoys can pass more than 100 checkpoints as they move goods from Aden to northern Yemen and vice versa. In a country reliant on external imports, all parties to the conflict must do better to facilitate the flow of goods, not make it harder.

It’s becoming more difficult for Yemen to stay afloat amid wave after wave of destruction. It’s crucial that the belligerents, concerned states, and aid agencies do what they can to provide a life raft — otherwise, Yemen will drown in a tsunami of preventable tragedies.

Alexandre Faite is the head of delegation for the International Committee of the Red Cross in Sanaa, Yemen. Follow him on Twitter at: @afaiteICRC.

Top photo: A woman walks through a cactus field in a drought-stricken area of western Somaliland, a semi-autonomous region in the north of Somalia. Successive droughts, made worse by El Niño weather patterns in the Horn of Africa, hit northern Somalia hard this year, leaving millions of people in need of humanitarian aid.

Seven-year-old Jamila draws her last breath as her father and mother wait by her bedside at Al Thawra public hospital in Yemen’s port city of Hodeida. In a country where 90 percent of goods, including food, are imported, shortages can easily lead to malnutrition.

Jamila sits with her mother, two days before succumbing to intestinal worms linked to malnutrition. Like many children in Hodeida, she needed to receive specialized medical care in Sanaa, but the cost of transferring her to the capital was too much for her family.

On the day this image was taken at Al Thawra, 74 patients were being treated in an emergency room designed to accommodate 12 people.

A state of emergency was declared in May following the outbreak of cholera, a highly infectious diarrheal disease that can kill within hours if left untreated. At Al Jumhouri hospital in the Yemeni capital of Sanaa, an elderly cholera patient sleeps among the chaos of the emergency room.

There are so few available beds at Al Jumhouri hospital that cholera patients are forced to sleep underneath occupied beds. As of mid-July, more than 1,700 people had died from the disease across the country.

At Al Sabeen hospital in Sanaa, a man waits outside an outdoor ward that was set up to deal with the rapid influx of cholera patients.

Majed sits next to his 60-year old mother, who is sick with cholera. She was one of the lucky ones: Majed managed to secure her a bed inside Al Sabeen, shielding her from rain and low temperatures at night.

Dozens of patients are cared for on the makeshift ward at Al Sabeen, which feels more like a jail than a hospital.

A man waits to learn whether his young daughters are infected with cholera at Al Sabeen hospital’s screening station.

Two-year old Raghad receives an injection to help her fight cholera. The International Committee of the Red Cross (ICRC) is supporting health facilities across the country to help contain the spread of the potentially deadly disease.

Raghad’s father sits next to her. The pair have struggled through rainy nights during her time at Al Sabeen’s outdoor ward. Hospital officials had no choice but to create the makeshift facility when they ran out of beds for new patients inside.