Providing urgent health care to millions: WHO and the Italian Agency for Development Cooperation work together to reach the most vulnerable
24 January 2019, Sana’a, Yemen — With a generous donation of 2 million euros from the Italian Agency for Development Cooperation, the World Health Organization (WHO) is scaling up efforts to meet health needs in Yemen through the health service delivery mechanism known as the Minimum Service Package. This is the first time since the start of the crisis in Yemen that WHO has partnered with the Agency.
This critical support will allow WHO to reach more than 600 000 of the most vulnerable people in need of essential health services in hard-to-reach areas of Al Hudaydah, Amanat Al-Asimah and Hajjah governorates. The objective is to provide health services through the Minimum Service Package while strengthening the health system with support from health partners across the entire country, ensuring the “right to health” for all Yemenis.
Cholera and malnutrition in Yemen threatens millions
27 December 2018 ─ Al Sabeen Hospital in Sana’a has admitted many cholera patients over the last 2 years, including infants as young as 2 months. Many of them also suffer from acute malnutrition. At the peak of the cholera outbreak more than 150 patients a day were being admitted to Al Sabeen hospital with severe watery diarrhoea. Some 20% of the total were diagnosed with cholera.
Two-and-a-half-year-old Ramez and eight-month-old Mohamed are brothers. Small and frail, they have been diagnosed with cholera and are moderately malnourished.
Their family moved from Hajjah to Sana’a after their father lost his job.
“In Hajjah we used to drink pure water from wells,” says the boys’ mother, “but after moving to Sana’a we had to drink from water trucks.”
It is almost 4 years since war erupted in Yemen, with devastating consequences for the country’s infrastructure and health system.
Despite ongoing humanitarian food assistance the latest IPC analysis - covering December 2018 to January 2019 - revealed 15.9 million people (53% of the population) faced food shortages. Of these, 17% of the population - about 5 million people - are classified as IPC Phase 4 (Emergency), and 36% - 10.8 million people - as IPC Phase 3 (Crisis).
Like millions of Yemenis, Ramez and Mohammed’s parents face a constant struggle to access healthcare, pay rent and feed their children.
“I have 3 more children. Their father is looking after them at home,” says the boys’ mother.
Within minutes she receives a phone call from her husband who tells her the children at home are starting to show signs of infection. They agree he should bring them to the hospital straight away.
Abdulmajeed Yahya is 8-months-old and weighs a little over 3 kilograms. He has been severely malnourished for over a month. He was diagnosed with cholera at Al Sabeen Hospital seven days ago, after making the 5 hour journey to Sana’a from Al Haymaharea with his mother and father.
“My husband lost his job after the war started and is now unemployed. We had to borrow money so we could come here from Al Haymaharea,” says Abdulmajeed’s mother.
Sana’a’s 22 May Hospital treats many internally displaced families. It, too, sees large numbers of patients with symptoms of cholera and children suffering medical complications as a result of malnutrition.
“We see two new patients suffering from cholera and malnutrition a day, many of them from families who own close to nothing. The hospital cannot accommodate in-patients so cases suffering from severe acute malnutrition with medical complications have to be referred to other hospitals,” says Suha Abdeen, a nurse on the hospital’s nutrition ward.
Jameel Moanis is 12-months-old and weighs just 3 kilograms. He was brought to 22 May Hospital a few days ago from Al Hudaydah and had to be referred to another hospital for more specialized treatment.
To help severely malnourished children suffering from medical complications WHO supports 269 health facilities in Yemen and has established 51 therapeutic feeding centres in 17 governorates. WHO has also established 72 diarrhoeal treatment centres and 25 oral rehydration centres for the treatment of cholera and other diarrhoeal diseases.
WHO works closely with the Ministry of Health and WASH cluster partners to contain cholera outbreaks, offering technical and logistical support to strengthen disease surveillance, assist diarrhoeal treatment and oral rehydration centres, train health workers on case management, deploy rapid response teams and improve sanitation and access to safe water.
There have been 280 198 suspected cases of cholera since the beginning of 2018, and 372 associated deaths. Children under 5 account fort 32% of the total suspected cases. Cholera has been reported in 22 out of Yemen’s 23 governorates, and 306 out of the country’s 333 districts.
WHO enhances access to basic health care in Yemen
17 December 2018 – Afaf, 7, has come to Aslam district to Al Jumhouri Hospital in Hajjah governorate, Yemen, a journey of more than a 100 km over difficult roads, to receive treatment for severe acute malnutrition and other problems.
“When we have money to seek medical care we take her to the hospital, but when we don’t she must stay at home until she recovers on her own,” said Um Afaf.
In the same hospital is Nabila Yahya. She has come from Al Shaghadira District with her six-week old daughter Amira.
“My husband is ill,” says Nabila, “and cannot find a job. He used to work as a taxi driver but then the price of fuel doubled and he could longer afford it. Now he stays home.”
Amira has been sick since she was born.
“Something is wrong with her throat and she can’t breastfeed. She suffered from diarrhoea and we took her to the health facility many times. Each time they released her she became ill again and had to be returned for further medical care,” says Amira’s mother.
“She has been in this health facility for a week now. She was admitted as an inpatient and they are treating her well.”
Around 50% of hospitals and health facilities in Yemen are either not working or functioning partially. People in many areas have to travel long distances in order to access basic health care.
To enhance access to health care for people who would otherwise have to travel hundreds of kilometres to receive treatment WHO and health partners support the Minimum Service Package (MSP) which focuses on eight priority health care services, targeting health facilities at the district level.
The MSP touches the lives of over 6.5 million Yemenis. It supports an estimated 125 health facilities and more than 2600 health care workers across the country. As MSP continues to expand, the hope is that more men, women and children will be treated.
Economic collapse, poverty and a lack of services have left a great many people vulnerable. They must struggle to survive, often in communities that have little awareness of health and preventive practices.
Ismail Mohammed lies in his mother’s arms in an MSP supported health facility in Al Mahabisha District of Hajjah Governorate. He bled heavily following his circumcision and is severely malnourished.
“Every time he used to breastfeed he would get diarrhoea. So we brought him to this health facility where he was tested. They said he had infections and provided him with therapeutic milk,” says Ismail’s mother.
Access to health care for all
Six-month old Yousra was brought to the MSP supported Al Shaheed Hospital in Khairan Al Muharaq. Severely malnourished and excruciatingly frail – she weighs just 3 kilograms – she cries constantly. Her father sits on the hospital floor with his second child next to him while his wife speaks to the doctor. They both seem disoriented and unsure what is wrong with their child.
“She has had a fever for over three weeks. Yousra’s father is unemployed and we have nothing and no one to support us,” says Yousra’s mother.
Al Shaheed hospital’s Dr Ali Al Ashwal says severe acute malnutrition with medical complications, as well as communicable diseases, are spreading in communities.
“Due to lack of resources and poverty families like Yousra’s are forced to use whatever means they can find to feed their children,” he says.
Yousra has been fed goat milk since birth. Dr Ali advises her parents she needs to be admitted for at least two weeks. She will be referred to Abs Health Centre where capacity for inpatients is available. It is an hour away from Al Shaheed hospital.
“We lack a therapeutic feeding centre with inpatient capacity here though we hope to be able to provide one soon.”
MSP provides essential services in health centres, covering nutrition, noncommunicable diseases and environmental health, trauma care, childcare, reproductive, maternal, newborn and child health. It aims to provide access to health care at all levels, targeting priority health needs and recalibrating an unbalanced health system.
With the generous support of our donors, including the World Bank, the Office of U.S. Foreign Disaster Assistance, Saudi Arabia, United Arab Emirates, Germany, Italy, Japan, EU Humanitarian Aid (ECHO), and Kuwait, we are working to ensure universal health coverage becomes a reality.
Leukaemia patients in Yemen suffer in silence amid war
20 November 2018 – Millions are living through the worst humanitarian crises in the world. In a world where basic infrastructure and services are a presumed part of daily life, Yemeni citizens struggle to meet simple needs of access to clean water, sanitation, food and primary health care. The energy formerly spent on development and capacity-building is being wasted on struggling to stay alive and healthy.
Almost four years of war has pushed an already weak health system to near ruin. People with chronic illnesses are struggling more than ever before to access treatment. The current situation forces 35 000 cancer patients – and nearly 11 000 new cases are diagnosed yearly – to hope only to survive rather than thrive. Almost half of the hospitals and health facilities have been destroyed due to the war, leaving the health system teetering on the brink of collapse.
The Leukaemia Centre in Sana’a is the only specialized leukaemia treatment centre for children in Yemen. With zero government support the Centre is in dire need of supplies and what is available covers only a fraction of the needs of incoming patients.
Tamir Abdulqader from Al Hudaydah governorate is seven years old and is one of three siblings. Pain in his joints three months ago prompted his mother to seek medical advice; unfortunately, he was misdiagnosed until he came to the Leukaemia Centre in Sana’a where he is currently receiving proper treatment. Tamir’s mother who accompanies him does not have anyone to support her, including her husband. “Once he learned about Tamir’s diagnosis, he told me that he is dead to him. We are divorced now and I don’t have anyone to help me” she says. Not only is she in debt after being forced to move to Sana’a for treatment, her two other children have been left with their grandmother in Al Hudaydah, who has been forced to sell her belongings just to make ends meet.
Poverty, vulnerability, and lack of supplies
Being the only specialized centre in Yemen, there is a great deal of pressure placed on the Leukaemia Centre that it is not equipped to take on. The sheer number of patients coming in from all governorates exceeds the available capacity and medical supplies. “Many patients coming in can’t afford to buy even the basic supplies such as an IV or cough medicine” says Dr Abdulrahman Al Hady, Director of the centre in Sana’a.
Shaima, seven, sits in the other room with her mother who accompanies her. In a pink headscarf, her tired little face seems even smaller, though her eyes still shine with the light of hope. She was diagnosed with leukaemia a few months ago after being in a car accident that injured her foot. “She was very scared and had a persistent fever for a few days after the accident. Her joints started to hurt her and that’s when I took her to the hospital,” says Shaima’s mother.
She tried two hospitals that rejected her admission before being admitted into the Leukaemia Centre. “We don’t have a place to stay, so we move around and stay with relatives whenever we can.”
With 22.2 million requiring humanitarian assistance, those with chronic diseases fall through the cracks
Many families of patients suffering from chronic diseases face devastating circumstances and struggles in their plight to access medical care. Poverty, lack of resources and medical care is common to millions of Yemeni people. About 75% – some 22.2 million people – require humanitarian or protection assistance, and more than half of them (11.3 million) require acute assistance, an increase of 1 million since July 2017.
The Leukaemia Centre continues to receive patients from all over the country in significantly rising numbers, while severely lacking supplies and medication. Only 20% or less of their needs are covered, and the death rate is higher than ever. “Sometimes incoming patients can’t afford to purchase the supplies that are not covered by the Centre, and out of compassion, doctors purchase these supplies themselves to assist those patients” Dr Abdulrahman adds. With the exchange rate of the US dollar increasing dramatically, prices of medication have sky-rocketed, tripling in price while most of the population struggle to put food on the table.
Hashed is six years old and has been sick for five months now. He sits on the hospital bed and his eyes are fixed on a very small TV screen on the wall playing children’s songs, his energy drained by his disease. His mother had to move to Sana’a from Ibb governorate with her thee children to seek treatment for Hashed. “He started experiencing pain in his legs. They became stiff which prevented him from walking,” says Hashed’s mother. After Hashed’s diagnosis they were advised to travel abroad for treatment that wasn’t available in the country, but they couldn’t afford the expense.
“We can hardly afford the medication prescribed here. We have to buy the cheaper brands because the good ones are very expensive,” she adds.
Dr Abdulrahman faces a sad reality daily, one that reflects the overall situation in Yemen. “Some patients die because life-saving medications are unavailable at the Centre. Some medications cost US$ 100 or more and people don’t have even a fraction of that amount.”
To add to this dire situation, health workers continue to work tirelessly for hours on end without a salary, thereby unable to provide for their own families.
WHO continues to support the National Oncology Centre in Sana’a and its branches in all governorates with various essential and life-saving anti-cancer medicines and chemotherapy medication. This medication is sufficient to cover the acute shortages of medicines for more than 30 000 cancer patients for one year — but this is not enough. More needs to be done or many more people will die from preventable and treatable diseases.