Chronicle of the Middle East and North Africa

Yemen: Cholera in the Time of War

A cholera-infected child receives medical treatment at a hospital in Sanaa, Yemen, 13 May 2017. Photo Eyevine

The Saudi-led military campaign, launched in March 2015, to bring the Iranian-backed Houthi rebels to their knees has so far failed.

The Houthis are no closer to winning either. At the time of writing, they were still in control of the capital Sanaa and several areas around it, despite air raids that have destroyed their ammunition depots and bases.

This stalemate, which is not expected to be resolved any time soon, has devastated the country. The United Nations (UN) estimates that at least 10,000 people have been killed, 3 million have been displaced and nearly 19 million are in need of humanitarian aid.

The latest catastrophe to hit the country is a cholera outbreak. Almost 167,000 cases have been reported since the outbreak began in April 2017 and 1,146 people have died, according to the World Health Organization.

Cholera is a bacterial disease spread by contaminated water. If not treated, it can kill within hours. The ongoing war has contributed to the current outbreak, according to the UN, but cholera is not new to Yemen.

Yemen’s water has never been clean, and sanitation and overcrowding have long been problematic, particularly in poor urban areas. The collapse of essential services such as trash collection and fluid and solid waste management has created the ideal breeding ground for the disease.

Add a rising number of malnourished people, and it is hardly surprising that the disease has reached epidemic proportions. Dr Luay Shabaneh, regional director of the United Nations Population Fund, which works with pregnant women and new-born babies, told Fanack, “1.1 million pregnant malnourished women are more likely to contract cholera, develop complications and risk death.”

Ironically, cholera is not a difficult disease to treat. Rehydration with oral rehydration salts or an intravenous solution and, in severe cases, antibiotics offers a good chance of survival. However, this requires medicines and a functioning health system. The availability of the former is impeded by a coalition-imposed blockade of Yemen’s sea, land and airports; the latter has collapsed.

The facilities that are running may even contribute to the problem, as patients are likely passing the disease between each other. These facilities are based almost exclusively in the main cities. Patients in rural or isolated areas have minimal access to medical care and aid workers are often prevented from reaching them by warring factions who control the roads.

In an attempt to halt the epidemic, UNICEF, the UN’s children’s agency, recently took the unusual step of paying Yemen’s medical workers, who have not received salaries for months. UNICEF’s regional director, Geert Cappelaere, said in an interview with the New York Times that Yemen’s health workers are crucial to the effort to combat cholera and that they should not be expected to work for free.

Instructions for making a simple rehydration solution with honey or sugar, salt and water have also been circulated on social media for those who have to rely on self-treatment.

Yet it is doubtful whether the poorest citizens can afford even that, assuming they are aware of the instructions. “In situations where a conflict hits a country whose infrastructure is already precarious, even basic measures become a luxury,” said Dr Shabaneh.

Another problem, as endemic to Yemen as unsafe water and at least as difficult to uproot, is corruption. A resident of Sanaa, who lives in one of the city’s poor, rubbish-strewn neighbourhoods, explained to Fanack how. “The Houthis buy the medicines, which are given by organizations like UNICEF, from the hospitals and then sell them to pharmacies outside the hospitals.”

These pharmacies sell them on to customers. “They are supposed to be free. And even though they are not sold for a very high price, most of the people have become very poor and cannot afford them, even if they are cheap.”

Hence, although ‘the largest stock ever of a cholera vaccine’ is due to arrive in Yemen in early July 2017, it is by no means certain that the drugs will end up where they are needed most.

Who is to blame for the outbreak? The Saudis and Houthis blame each other.

The question seems moot as the death toll mounts. But if one party blames the other, little cooperation can be expected and vaccination campaigns may cause new tensions about who gets the drugs and where.

With summer temperatures and humidity on the rise, especially in the lower regions of Tihama and the south coast, and the rainy season starting in the northern highlands, the outbreak is likely to become even harder to contain.

That brings other problems with it. People will do almost anything to find the money to buy medication. Taking children out of school and marrying off very young daughters are just some examples.

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