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War, Hunger and Now Cholera: Yemen's Crisis Worsens


September 7, 2017
Sudarsan Raghavan / The Washington Post & Megan O'Toole / Al Jazeera

Last December, the main hospital in the city of Hajjah in northern Yemen had already received 200 suspected cases of cholera. The patients were being treated at a month-old cholera center supported by the World Health Organization. Today, the number of suspected cholera cases in Yemen has reached half a million and nearly 2,000 people have died. It is now the largest cholera epidemic in the world.

https://www.washingtonpost.com/news/worldviews/wp/2017/08/26/cholera-strikes-the-middle-easts-poorest-nation/



Yemen's 'Man-Made' Cholera Epidemic So Much Worse Than Ever Predicted

War, Hunger and Now Cholera: Yemen's Crisis Worsens
Sudarsan Raghavan / The Washington Post

(August 29, 2017) By last December, the main hospital in the city of Hajjah in northern Yemen had already received 200 suspected cases of cholera. The patients were being treated at a month-old cholera center supported by the World Health Organization.

Across the country, UN workers had recorded 122 confirmed cases by then, including 10 confirmed deaths and 72 suspected deaths.

Today, the number of suspected cholera cases in Yemen has reached half a million and nearly 2,000 people have died, the WHO recently reported. It is now the largest cholera epidemic in the world.

Only a few years ago, the waterborne disease had been nearly eradicated in Yemen.

When I visited the Hajjah hospital, it was hard to imagine another instigator tormenting the poorest nation in the Middle East. War-ravaged Yemen was reeling from a severe hunger crisis and worsening poverty. Parents were being forced to choose between taking their sick children to the hospital and feeding their healthy ones.

The hospital itself was in shambles. Ventilation machines and other essential equipment were broken. The staff had not been paid in four months. The facility owed $55,000 to the water department in unpaid bills.

If it wasn't for international funds, the hospital would have never opened the cholera center. Still, when I was last there, the disease seemed to be the least of Yemen's many woes.

The outbreak started to spread fast at the end of April, propelled by poor sanitation and limited access to clean water for millions of Yemenis. And although its spread has slowed in some areas, it is speeding up in other zones, infecting an estimated 5,000 people per day, the WHO said.

All this as the health system has further crumbled. Airstrikes from a Saudi-led coalition fighting Houthi rebels have destroyed or damaged more than half of Yemen's heath facilities. A lack of funds has forced others to close.

Shortages of medicine and supplies have grown dire, largely because of a Saudi-imposed economic blockade and bureaucratic delays by Houthi officials. The hunger crisis is propelling the country toward famine, leaving even more of the population vulnerable to diseases such as cholera.

About 30,000 government health employees vital to fighting the epidemic have not been paid in nearly a year, according to the WHO.

"These doctors and nurses are the backbone of the health response -- without them we can do nothing in Yemen," Tedros Adhanom Ghebreyesus, the director general of the WHO, said in a statement. "They must be paid their wages so that they can continue to save lives."

The reemergence of cholera is the latest fallout from a crushing war driven by regional and sectarian rivalries, and backed by Western powers. Saudi Arabia and its neighbors are seeking to restore Yemeni President Abed Rabbo Mansour Hadi, who was ousted by the Houthis in early 2015. The region's Sunni rulers are wary of the Shiite Houthis, who are widely believed to be backed by Iran, Saudi Arabia's main rival.

The Saudi-led coalition has largely used US and British weapons that have killed thousands of Yemeni civilians. The United Nations estimates that more than 10,000 have died and 3 million have been driven from their homes.

"This is no accidental disaster -- it is a man-made disaster driven by national and international politics," Katy Wright, the head of advocacy for Oxfam said last week in a statement, referring to the cholera crisis. "In backing this war with billions of dollars of arms sales and military support the US and the U.K. are complicit in the suffering of millions of people in Yemen."

An Oxfam study released last week found that many Yemenis are now being forced to make a stark choice: treating cholera-infected family members or putting food on the table.

"The current rainy season is likely to aggravate the spread of cholera and other diseases can easily break out, as a recent increase in meningitis cases shows," the report said. "And all efforts to contain the multitude of crises have failed so far."



What is Fuelling Yemen's Cholera Epidemic?
Megan O'Toole / Al Jazeera

(September 5, 2017) -- With Yemen mired in the third year of a war led by Saudi Arabia and its allies, the country's population is facing a humanitarian crisis of unprecedented proportions.

More than 20 million Yemenis require humanitarian support, with nearly half of those in acute need of assistance, according to the United Nations. This year, a new wave of cholera cases further devastated the population, infecting hundreds of thousands of people and killing more than 2,000. Aid agencies have warned that without urgent action, the situation will continue to deteriorate.

Analysts have described the Saudi-led offensive in Yemen as a strategic failure, but although Saudi's crown prince recently expressed his desire for an exit strategy, there is no immediate end in sight -- and the humanitarian consequences will endure long after the bombs stop falling.

Al Jazeera spoke with Tarik Jasarevic, a spokesperson for the World Health Organization, about the impacts of the current cholera epidemic on Yemen's vulnerable population.

Al Jazeera: What led to this outbreak in the first place, and what factors have fuelled its rapid spread?

Tarik Jasarevic: Cholera is endemic in Yemen. Two-and-a-half years of intense conflict have exacted a heavy toll on the country's health system and water and sanitation services.

This is the second wave of an outbreak that started in October 2016. We are entering the peak season for the spread of diarrhoeal diseases in Yemen.

There has been a gradual disintegration of the municipal water infrastructure and systems in a context where few civil servants are being paid, and a relatively small trigger like a period of heavy rain or burst pipes creates a backflow of sewage into water pipes, an overflow of latrines and septic tanks, etcetera.

Al Jazeera: What areas of Yemen have been hardest hit, and can you describe some of the cases that you've come across in these areas?

Jasarevic: Cases are reported in 22 governorates and 300 districts, comprising more than 90 percent of Yemen. We frequently see children who come in to the treatment centres with suspected cholera who are also malnourished.

Malnutrition weakens the immune system of these children, while diarrhoeal diseases like cholera exacerbate malnutrition. It's a vicious cycle in a country where 17 million people don't know where their next meal is coming from.

Al Jazeera: This has been described as the world's worst cholera outbreak. Can you put this into context?

Jasarevic: Yemen faces the world's largest cholera outbreak, with 607,065 suspected cases and 2,047 deaths reported since April 27, 2017, as of this week.

"Worst" can mean different things to different people, such as number of deaths, number of cases, proportion of population, or proportion of country geographically affected.

In a roughly three-month period following the cholera outbreak in October 2010, Haiti had 50 percent more cases on a per population basis and over 200 percent more deaths.

Yemen's current cholera outbreak is the largest in terms of scale of suspected cases at the current time, though not necessarily the largest historically. In any case, these comparisons are not meaningful. Comparing Haiti and Yemen is not helpful in describing either epidemic. What matters is the impact on the country, and we can see this is a heavy burden to bear.

Al Jazeera: What is the typical prognosis for someone who contracts cholera in a war-torn and resource-starved country such as Yemen?

Jasarevic: Cholera treatment is relatively straightforward: oral rehydration solution for mild cases and a combination of antibiotics and intravenous fluids for severe cases.

But cholera can also kill within hours if left untreated, and access to health services during conflict can be extremely challenging. In Yemen today, nearly 15 million people cannot access basic health services, and only 45 percent of health facilities are in service.

Less than half of the $190m that the WHO needs for an effective humanitarian response in Yemen for this year has been received.

Al Jazeera: Can this outbreak be brought under control, and what would be needed to make that happen?

Jasarevic: Our response to cholera in Yemen is working, but we must scale up. More than 99 percent of people who become sick with suspected cholera and who are able to access health services in time do survive.

To effectively end the outbreak, we must reinforce surveillance to detect and monitor the spread of the disease, expand access to clean water and sanitation and to medical treatment, and work with communities on prevention.

Individuals have an important role to play in keeping themselves and their families safe from cholera. Engaging communities is, therefore, a key pillar of the cholera response. WHO and UNICEF supported local health authorities to conduct a nationwide house-to-house awareness campaign from August 15-30.

Throughout the campaign, more than 13 million people in 21 governorates were engaged. Forty thousand volunteers travelled from door to door, providing information on proper hand-washing, preparation of oral rehydration solution, and proper home care of the people with cholera, including referral to health facilities.

Posted in accordance with Title 17, Section 107, US Code, for noncommercial, educational purposes.

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