Hello everyone and welcome to this week's blog post. In this article, I will be talking about the healthcare infrastructure in Yemen and how it will be affected by the COVID-19 pandemic.
For the past six years, the people of Yemen have been locked in a brutal civil war which has killed over 100,000 people (due to the conflict and famine resulting from the war), in addition to displacing millions more. This has resulted in Yemen becoming the largest humanitarian crisis in the world. According to UNICEF, 24 million people including 12 million children are now in need of humanitarian assistance.
As of July 2020, Yemen is controlled by four major groups - the Hadi-led government (supported by Saudi Arabia and many Western countries), the Supreme Political Council, the Southern Transitional Council and Al Qaeda. This means that there is not a central government in charge, so any healthcare policy can't be coordinated across the country.
Since all of these groups are fighting each other for control of the region, none of these groups are spending on healthcare. Because of this, the healthcare infrastructure in Yemen has completely collapsed, with only half of the healthcare facilities in the country actually functioning in any form. Moreover, those working in these facilities are often going without pay and having to make do without basic equipment or supplies.
The conflict in Yemen has decimated other areas of infrastructure, which all have a severe impact on healthcare provision. For example, due to the conflict, the sewage and sanitation infrastructure in Yemen have been destroyed and most sanitation workers are no longer being paid. Consequently, the transmission of infectious diseases in Yemen has skyrocketed. Currently, Yemen is facing the worst cholera outbreak anywhere in the world. In just the first year of the outbreak, the UN reported over 815,000 cases of the disease, with children accounting for over half of these cases.
What is particularly sad about this epidemic is that cholera can usually be easily treated, by using oral rehydration salts and clean water. However, due to the conflict, the distribution of these medications is incredibly difficult. Moreover, cholera could also be prevented by boiling the water before consuming it. Yet, without having clean water supplies or money to buy gasoline, this is very difficult.
Additionally, roads and the transportation infrastructure in Yemen have been hit heavily due to the conflict, poor maintenance, destruction due to bombing campaigns and checkpoints by various militias along the roads. This has major implications on the health of the nation, as people aren't able to quickly get to hospitals if they need medical assistance. Furthermore, this also means that vital hospital equipment is stuck at ports while hospitals and other medical facilities have very little resources to treat patients.
This lack of resources has to lead to a booming black market for food and vital medicines. Not only does this exacerbate inequality in the region, as only the more wealthy people can afford medical treatment, but these medical supplies are often smuggled into the country and distributed by unofficial groups, such as the militias controlling Yemen. As such, the money obtained by the sale of these medical supplies are often used to fund the conflict, which only makes the humanitarian crisis in Yemen even worse.
According to the United Nations Humanitarian Chief, in 2017, a child under the age of five in Yemen died every 10 minutes due to preventable causes. Every day, many die as a direct result of the bombings and conflict. In addition, there are many so-called 'silent deaths' which go largely unreported. These are due to malnutrition (as the fighting has caused a famine in Yemen for the last few years) and the fact that people with chronic conditions, such as diabetes, are not able to receive life-saving treatment.
As one might expect, the civil war in Yemen has meant that mental health care in the country is almost non-existent. Not only does this mean that people with existing mental health conditions, such as schizophrenia and ADHD, can't receive specialist treatment, but it also means that there is no support available for those suffering from PTSD or other mental health conditions related to the conflict.
According to the United Nations, COVID-19 could be much more deadly in Yemen than in other countries. This is because of numerous reasons. The country still at war, which makes humanitarian organisations hesitant to deploy staff and resources in case they are destroyed or stolen by rebel forces. Additionally, the conflict has meant that transportation links in the country have been destroyed, meaning that medical supplies can't be distributed as easily to medical professionals. Since supplies like gloves and masks can't be distributed easily, it is highly likely that those treating patients with COVID-19 will also fall ill, thus reducing the capacity for treatment in the long term.
Due to the famine in Yemen, malnutrition is a major problem for its civilians. According to UNICEF estimates, approximately 1.5 million children in Yemen are malnourished. As a result, many people's immune systems are weakened, making them more vulnerable to COVID-19. Consequently, it is vital that humanitarian organisations can deliver food and cooking supplies to people who need it the most so that the effects of COVID-19 are minimised.
As a result of limited testing availability and poor logistics networks, the number of coronavirus cases in Yemen is unknown. This means that any coordinated action against coronavirus is almost impossible, as the organising body won't be able to know which areas of the country to target.
In the long term, COVID-19 will also likely significantly affect the population of Yemen. This is because many international organisations, such as the United Nations Refugee Agency, have lost vital funds, resulting in them pulling out of humanitarian projects in Yemen. Without these projects, the development of Yemen will be halted, people in Yemen will suffer during the conflict and recovery after the war will be much slower.
Further, all schools in Yemen are now closed due to the pandemic, which means that children in Yemen will not receive a proper education. Without this, recovery in Yemen will be much slower, as children won't be able to access high paying, skilled jobs, so average earnings will remain low.
In conclusion, due to the conflict, the healthcare infrastructure in Yemen is completely crippled, which is incredibly harmful to the Yemeni people, as many diseases can't be treated. Further, due to COVID-19, the healthcare infrastructure in Yemen will likely stay damaged for several years, as many facilities have been destroyed by the conflict and the government of Yemen is bankrupt, so won't have any funds to spend on rebuilding the country.
In order to significantly improve the health of civilians in Yemen, a temporary ceasefire is essential. This is because it would increase the safety of the country, which is important in getting humanitarian aid to civilians. Indeed, due to multiple attacks on MSF hospitals, Medecins Sans Frontieres evacuated its staff from hospitals in Northern Yemen in 2016, clearly underlining how safety is required for aid to be deployed. If a temporary ceasefire can be achieved in Yemen, then organisations are much more likely to deploy humanitarian aid in the region.
Nevertheless, while a temporary ceasefire would provide some relief to the Yemeni citizens, the only long term solution is an end to the conflict, as this would provide the security needed for investments in Yemen. Without conflict in the area ceasing, infrastructure (roads, hospitals, schools etc) can't be rebuilt and the quality of life in Yemen will remain low. In addition, an end to the conflict would also allow regular humanitarian aid to reach people in the country and would also hopefully reduce dependence on the black market. While the recovery of Yemen would take an incredibly long time, even after the conflict ends, it is the only long term solution for the humanitarian crisis.
To conclude, therefore, I think that all governments, especially those supporting the conflict with military means, should try and encourage dialogue between the opposing forces and try and establish a temporary ceasefire. Once this ceasefire is established, they should then try to maintain it for as long as possible.
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