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Yemen: “COVID-19 has made the health system's collapse complete”

10 Jun 20
This article is more than one year old

Yemen: “COVID-19 has made the health system's collapse complete”

A view of Dahadh camp in Khamer, Amran governorate. Caption
A view of Dahadh camp in Khamer, Amran governorate.

“At first, there were many volunteer doctors and nurses around,” remembers Dr Nizar Jahlan, “but when they knew that cases were coming to the hospital, they all disappeared.”

This is how the story of COVID-19 began in Sana’a, the capital of Yemen, where Médecins Sans Frontières/Doctors Without Borders (MSF) is supporting the Ministry of Health to run the city’s principal centre to treat the new coronavirus and is planning to expand that support in the coming weeks.

Fear and denial amid difficulties

“At the beginning, we faced many difficulties; the hospital lacked almost everything that it needed, but we brought in what we could in terms of drugs, and personal protective equipment to start activities,” said Dr Jahlan, who is MSF’s Medical Activity Manager for the project.

“But then we faced problems in finding enough doctors and nurses willing to work in the hospital.”

This is a country that lacks almost totally the means to respond to this outbreak, so it’s understandable that people are scared.

Claire HaDuong
|
MSF Country Manager, Yemen

“There has been a strange mixture of fear and denial about the virus here,” said Claire HaDuong, MSF’s Country Manager in Yemen.

“People haven’t wanted to accept the possibility that it could arrive, or that it was already circulating.”

“But as soon as people have been faced with a case, it has caused panic,” said HaDuong.

“But then this is a country that lacks almost totally the means to respond to this outbreak, so it’s understandable that people are scared.”

Coronavirus has taken hold in Yemen

Unfortunately, it is no longer anything but obvious that the virus is circulating widely across the whole of Yemen.

It’s most evident in the intensive care unit in Sana’a, which has 15 beds and has been full most of the time for the last four weeks, and where the team have witnessed a high rate of deaths.

At MSF's out-patient department in Batil refugee camp Gandhi Pant, a nurse, escorts a patient with a possible appendicitis to a waiting ambulance. 

Batil is one of three camps in South Sudan’s Upper Nile State sheltering at least 113,000 refugees who have crossed the border from Blue Nile state to escape fighting between the Sudanese Armed Forces and the SPLM-North armed group. Refugees arrive at the camp with harrowing stories of being bombed out of their homes, or having their villages burned. The camps into which they have poured are on a vast floodplain, leaving many tents flooded and refugees vulnerable to disease. Mortality rates in Batil camp are at emergency levels, malnutrition rates are more than five times above emergency thresholds, and diarrhea and malarial cases are rising.

Help us prepare for the next emergency

People enter the emergency room walking, but they are already deeply deprived of oxygen without being aware of it, and they die in a surprisingly short amount of time. That is shocking.

Dr Nizar Jahlan
|
MSF Medical Activity Manager

The teams have treated hundreds of patients with respiratory symptoms in each of our COVID-19 centres in Sanaa and Aden, and other centres that MSF runs or supports in the north of Yemen, such as in Hajjah, Khamer, Ibb, Haydan, and Hodeidah have also received patients, although in fewer numbers.

“I have been working in intensive care units for more than 14 years, and what’s new to me is the dramatic way in which people are dying here,” said Dr Jahlan.

“They enter the emergency room walking, but they are already deeply deprived of oxygen without being aware of it, and they die in a surprisingly short amount of time. That is shocking.”

People arriving in very critical conditions

“Unfortunately, this seems to be a by-product of the fear about the virus,” explained HaDuong.

“People are waiting to come to the hospital until it’s much too late, and it makes it incredibly difficult to save them.

"We are saying to people: most cases of this virus will be mild, but please, if you have breathing difficulties, come sooner rather than later to see us.”

Dr Jahlan now knows all too well how the patients feel: after weeks of working in the treatment centre with seriously ill patients, he became unwell himself.

A hospital worker salvages the remains of undamaged medication and equipment left in the emergency room after the 15 August Saudi-led coalition airstrike which destroyed the hospital killing 19. 

In a country where access to healthcare is already extremely limited, the Abs hospital was the only facility catering to over 2,000 IDPs in the area and thousands more along the coast, from the northwestern border of Yemen to the outskirts of Hodeidah. With the destruction of Abs hospital, the closest hospital is now over 3 hours drive away.

Our work in Yemen

Find out more about the humanitarian crisis gripping the country

“I think it was the most difficult time of my life,” he said. “I felt that I was just gasping for breath, I worried that I was dying, I had such a high fever.”

At first his wife was looking after him, and then she too became sick. Both, thankfully are now better, but he says that many people he knows have not been so lucky.

“A lot of my friends, especially those of them who are doctors, have been sick,” said Dr Jahlan.

Five years of fighting had caused Yemen’s healthcare system to collapse in large parts... Now COVID-19 has made that collapse complete, with many hospitals closing for fear of the virus.

Claire HaDuong
|
MSF Country Manager, Yemen

COVID-19 has completely collapsed the health system

“Five years of fighting had caused Yemen’s healthcare system to collapse in large parts,” said HaDuong. “Now COVID-19 has made that collapse complete, with many hospitals closing for fear of the virus, or for lack of staff and personal protective equipment.”

“Many people will die of this virus, but we fear that many others will also die from what should have been preventable deaths because healthcare is simply not available,” said HaDuong.

We are doing all we can to both keep our regular healthcare programmes open and respond to the COVID-19 outbreak in the country, but it remains difficult to bring staff and supplies into the country.

The scale of the needs is also too great for any single organisation to respond to.

We cannot face this crisis alone... The United Nations and other donor states need to urgently find ways to step up the response... and the local authorities need to facilitate the work of international organisations like MSF.

Claire HaDuong
|
MSF Country Manager, Yemen

“We cannot face this crisis alone,” said HaDuong. “The United Nations and other donor states need to urgently find ways to step up the response, including through hands-on interventions of medical humanitarian agencies and support to the Yemeni health system with money to pay healthcare staff, equipment to protect them, and oxygen concentrators to help sick patients breathe.”

“The local authorities need to facilitate the work of international organisations like MSF who are working with them to respond to the virus,” said HaDuong. “They need to ensure the entry of medical supplies and international staff to reinforce teams on the ground.”

1_1_Patients

108,200

PEOPLE ADMITTED TO HOSPITAL BY MSF IN YEMEN IN 2022

5_1_surgery

36,500

SURGICAL INTERVENTIONS BY MSF IN YEMEN IN 2022

8_8_Births2

35,500

BIRTHS ASSISTED IN BY MSF IN YEMEN IN 2022

As for Dr Jahlan, he is now preparing to get back to work after his recovery from the virus. “A lot of my friends and colleagues were shocked that I would go back to work in the COVID-19 centre,” he said. “They asked me, ‘are you crazy?’”

“I told them that now I am more motivated than ever, because now after being sick I know how much these patients are suffering from the virus, and how much they need us.”