We're pleased to feature a guest post by Ibrahim Daair on the recent outbreak of cholera in Yemen, where the healthcare system has already been devastated by war and poverty. This article originally appeared on The Conflict Comment blog. This post does not necessarily reflect the positions of the YPP; YPP staff have not attempted to fact-check or independently verify the information reported herein. With the war leaving many of the country’s hospitals in ruins, a cholera outbreak could push Yemen’s health system over the brink, further shattering the already traumatised country.
Government officials in Northern Yemen have confirmed several cases of cholera, and this news cannot come at a worse time for the country, already one of the world’s poorest, as it undergoes a violent war involving neighbouring Saudi Arabia.
The majority of cholera cases have been reported in Sana’a. The World Health Organization (WHO), citing the Sana’a based Ministry of Health, reported 11 confirmed cases in the capital.
WHO officials also stated that the disease does not appear to be spreading. However, local media, quoting medical sources, also contained reports of two children contracting cholera in the southern governorate of Lahj. Local government officials were quick to deny the reports, claiming they were cases of food poisoning.
Cholera, which causes severe dysentery and vomiting, can develop in areas with poor sanitation and is contracted by coming into contact with contaminated water sources. Without effective treatment the disease can have a mortality rate of up to 90 per cent.
Any disease outbreak will undoubtedly put additional strain on a health system struggling to cope with the effects of war. The UN estimates that around 10,000 civilians have been killed due to the conflict; the majority by Saudi airstrikes.
A coalition of Arab states led by Saudi Arabia began a bombing campaign in March last year after Ansarullah (Houthis) and forces loyal to former president Saleh took control of large territories across Yemen, forcing the internationally recognized government of president Hadi into exile in Saudi Arabia.
Yemen has been in a state of upheaval since 2011, when popular protests forced president Saleh from power. Saleh handed power to his deputy Abd-Rabbuh Mansour Hadi in a deal which gave him immunity from prosecution. The deal, sponsored by the GCC states, was seen as giving Saleh the ability to wreck Yemen’s transition toward democracy.
Yemen’s hospitals have not been immune to the war. Several have been targeted throughout the country. In August, a Saudi airstrike hit an MSF run facility in the North-West of the country. The attack killed 19 and destroyed the last functioning hospital in the area.
Julien Harneis, UNICEF’s Yemen representative, said ‘Children are at a particularly high risk if the current cholera outbreak is not urgently contained especially since the health system in Yemen is crumbling as the conflict continues.’
Furthermore, the medical situation is worsened by the nation-wide blockade enforced by the Saudi-led coalition on the country. By barring all sea and air traffic into Yemen, the Saudis aimed to turn public opinion against the rebels and pressure Ansarullah and Saleh loyalists to retreat from the capital.
However, more than a year on, it has had devastating effects on the country’s medical system, making it extremely difficult to import medication. Hospitals throughout the country have reportedly had to turn away patients because they lack the capacity to treat them.
The blockade is being blamed for an increasingly wide-spread humanitarian crisis. Reports indicate that up to 80 per cent of Yemen’s population is in need of humanitarian assistance, while malnutrition is affecting up to 1 in 3 children.
In addition, Yemen has suffered chronic water shortages as a result of poor management and inefficient infrastructure to conserve drinking water. Yet despite the on-going war, farmers are still producing the local cash crop. The production of Qat, a leaf that acts as a mild stimulant when chewed, consumes a large amount of water. With Qat and mismanagement already putting pressure on water resources, the war is exacerbating the situation by making it difficult for many to access clean drinking water. A vital resource in combatting the spread of cholera.
This week, the Saudi-led coalition was accused of bombing a funeral hall in the capital Sana’a which led to the deaths and injury of hundreds of attendees. After initially denying any involvement, the Saudis have apparently accepted responsibility in the wake of an international outcry. The scale of the bombing led hospitals in the capital to issue a call for volunteers to donate blood to critically injured survivors.
UN secretary-General Ban Ki Moon labelled the attack ‘an outrageous violation of international humanitarian law’ and called for a full inquiry. He also condemned all sides for attempting to ‘hide behind the fog of this war’.
The UN has organized a number of peace talks in a bid to end the war. The latest round of negotiations in Kuwait earlier this year fell through after Saleh’s party, the GPC, and Ansarullah unilaterally announced the formation a new government.
Last month the Saudi backed government in exile announced that it would move the central bank to Aden, the temporary capital. The bank was seen as the last functioning non-partisan bureaucracy keeping the economy from completely collapsing.
On the other side, the Houthis and Saleh are not willing to surrender their weapons nor allow the exiled government to return to power in Sana’a.
As the fighting continues the financial cost of the war is mounting on Saudi Arabia. The unintended length of the war coupled with a persistent slump in oil prices and growing financial crisis are putting heavy pressure on the Saudi monarchy to get out of the Yemeni quagmire. The quickest way out for the Saudis would be to drop Hadi and allow the formation of a unity government without him. However, this would involve a serious loss of face that the kingdom’s rulers cannot tolerate.
For any meaningful peace to be negotiated all sides must move away from their increasingly entrenched positions and think in terms of their, and Yemen’s, future interests. A long protracted war will only serve to further destroy the country and diminish public support for either side.
The current war is not the only concern to bear in mind: “The only thing keeping the country’s ‘two sides’ together are shared enemies” said Adam Baron, a journalist on Yemen. Those divisions have not gone away, rather the war has simply placed them on the back burner.
During his tenure as president Saleh fought six wars against the Houthis. For their part the wide confederation fighting alongside the Hadi government includes local tribes, Al-Qaeda and secessionist elements; many of whom are also deeply opposed to Hadi. In the event of the current war coming to an end, Yemenis will still face the daunting task of keeping the peace between the many heavily armed sides.
The cholera outbreak is the latest in a long line of events pushing the Yemeni population to its limits. Unless steps are taken to stop this outbreak in its tracks, the addition of a serious medical crisis could turn Yemen into an even greater humanitarian catastrophe.