Zahra and Mohammad don’t know each other but they share the same misery as do many others in Yemen who had a kidney transplant.  On 12 January 2017, Zahra passed away from kidney failure due to the lack of her immunosuppressant medication in the market, a medicine that her doctor told her would have to be taken the rest of her life to ensure her body does not reject the transplanted kidney her family fell in debt for 8 years ago in an attempt to cover the operation’s expenses.  Mohammad, on the other hand, has not died yet but has been seeking charitable contributions because he suffered kidney failure this past week, 19 years after his transplant operation and for the same reason, a lack of his immunosuppressant medication in the market. This ever growing phenomenon is not without an unknown cause.  It is due in large part by a US backed Saudi-led Coalition blockade that has been imposed on food, medical and fuel supplies attempting to enter Yemen.

Not only has a blockade been imposed since the outset of the war on Yemen, over the course of the first 600 days, Saudi-led coalition airstrikes targeted 263 medical facilities in Yemen. The targeting of medical facilities along with the systematic and widespread blockade on Yemen have led to the almost near total collapse of the healthcare system. As a result, over 14 million Yemenis are currently in dire need of health care services.

On 26 March 2015, a coalition consisting of the UAE, Qatar, Kuwait, Bahrain, Egypt, Jordan, Morocco, later joined by Sudan and Senegal and led by Saudi Arabia launched a military intervention to “defend the legitimate government of President Hadi from the takeover attempts by the Houthi militias in Yemen” as announced by the then Saudi ambassador to the United States.  Throughout the war, the line between what is deemed legitimate and illegitimate targets was blurred.  Medical workers, services, and infrastructure, which in theory must be spared from armed conflicts, were a target.

Airstrikes on Health Care Facilities

The Saudi-led coalition airstrikes and threat of airstrikes against health care workers facilities, and the infrastructure supporting the sector impede the ability of millions of people in Yemen from receiving the health care services they are in dire need of.  A report by the Office for the Coordination of Humanitarian Affairs (OCHA) claims that by the end of the first month of war, the Yemeni Ministry of Health estimated that 95 percent of the foreign medical workforce evacuated the country because of the dangers to life and limb posed by the war.

According to the Legal Center for Rights and Development, a local Yemeni non-governmental organization, 263 medical facilities were struck by airstrikes in the first 600 days of war, including those facilities operated and supported by Medicins Sans Frontieres (MSF), commonly known as Doctors Without Borders – the most recent of which killed at least 15 people when warplanes bombed Abs Hospital in Yemen’s northern Hajjah governorate on 15 August 2016.  According to the hospital director, Ibrahim Aram, three Yemeni staff members of MSF were among the dead, three foreign doctors at the hospital were also wounded, and three other staff members had their limbs amputated.  This last attack came after three other attacks on MSF-supported facilities and led MSF to evacuate its staff from Northern governorates in Yemen, further reducing the medical services available in the country. The three other hospitals supported by MSF alleged to have been targeted and struck by Saudi-led Coalition warplanes include Shiara Hospital in the Saada governorate on 10 January 2016 in which five people were killed and eight others were injured, Alhouban Clinic in the Taiz governorate on 2 December 2015 in which  9 people were wounded including two MSF staff members, and Haydan Hospital in the Saada governorate on 26 October 2015 in which one person was wounded in the leveling of the hospital.  The destruction of the Haydan Hospital prompted MSF head of mission in Yemen, Hassan Boucenine, to state that “this attack is another illustration of a complete disregard for civilians in Yemen, where bombings have become a daily routine.”

Double Tap Airstrikes on First Responders and Rescuers

Not only were 263 healthcare facilities struck in the first 600 days of war, even first responders and rescuers were targeted, killed and injured when they arrived at a scene to gather the dead and assist the injured after a bombing took place. One such incident occurred on 21 January 2016 when at least 20 people were killed and another 35 wounded, in what medics claim was a deliberate double-tap strike attack on a residential building in the Dhahyan district of Saada. Following the initial airstrike on the residential building, first responders rushed to the scene to care for the wounded and collect the dead.  Coalition warplanes soon returned to strike again killing over 10 first responders. Shortly thereafter, a third airstrike hit the ambulance at the scene, killing the driver who was working at a clinic supported by MSF.

According to the Yemeni Health Ministry spokesperson Dr. Nashwan Attab, these double-tap airstrikes are intended to “completely eliminate the few remaining medical staff in the province.” Teresa Sancristoval, emergency coordinator at MSF, expressed her sorrow stating that “this latest loss of a colleague is devastating, and it demonstrates the ruthlessness with which healthcare is coming under attack in Yemen…People there are being subjected to this kind of violence on a daily basis. No one, not even healthcare workers, are being spared.”

These double-tap airstrikes continue unabated with impunity. A more recent incident occurred on 8 October 2016 at 3:30 P.M. when warplanes targeted a funeral hall in Sanaa, where over 2,000 civilians were paying their condolences to a deceased member of the Al Rowaishan family.  The first set of airstrikes hit the hall bringing down the roof and with the force of the explosion killed and injured many people inside. As first responders rushed to the entrance to rescue the injured and remove the dead, a second double-tap airstrike hit adding to the casualty count that numbered in the hundreds. In the end, 195 deaths were reported and over 843 injuries amounting to the largest number of casualties in an airstrike operation since the war began.

These are just some of the many tragic incidents where the Saudi-led coalition employed double-tap  airstrikes on first responders to directly interfere with the access to or delivery of medical services to those in dire need of it. The coalition has systematically interfered with access to health care in a more comprehensive manner, however, with its imposition of a land, air and sea blockade on the entire population and territory of Yemen that has blocked food, medical and fuel supplies from entering Yemen’s ports.

Effects of a Comprehensive Land, Air, Sea Blockade on Healthcare Services

The 50,000+ civilian deaths and injuries coupled with the destruction of Yemen’s health care sector and overall civilian infrastructure occurred in the context of a unilateral decision by Saudi Arabia and members of its coalition to launch a war employing airstrikes and a blockade on Yemen without a UN mandate.  The relevant U.N. Security Council Resolutions – 2140 and 2216 – which involve an arms embargo, asset freeze and travel ban on five named individuals are not resolutions sanctioning war and in no way make permissible the imposition of a comprehensive land, air, and sea blockade that blocks regular trade, both import and export, in commercial goods as well as humanitarian aid. Yet, the collapse of basic health care services in Yemen continues to accelerate due to the blockade. According to OCHA, three million children and pregnant or lactating women require malnutrition treatment or preventive services. Solid waste removal has come to a halt in several areas as over 19 million people lack clean water and sanitation. And to make matters more troublesome, health care service availability is rapidly contracting due to the direct impact of the war and the lack of sufficient resources to pay salaries and thereby the inability to maintain operations and services.

Back in March 2016,  UNICEF’s Representative in Yemen, Julien Harneis, stated that nearly 10,000 children under the age of five died from preventable diseases due to the collapse of the country’s health system, stating that those children would not have died if it were not for the war. He also stated that 10 million children, or 80 percent of all of Yemen’s children, are in need of urgent humanitarian aid and around 460,000 children are at risk of severe acute malnutrition.  Again, this would not be the case but for this war.  More recently, on 16 December 2016, OCHA Humanitarian Coordinator Jamie McGoldrick stated that a child dies every ten minutes from preventable diseases in Yemen, so it hits home that’s one hundred forty four 144 children per day.

Allowing for commercial and humanitarian aid imports to resume and facilitating the unfettered distribution of necessary food, medical and fuel supplies to all locations in Yemen are essential to stemming further rapid increases in humanitarian needs of the Yemeni people. Since the outset of the war, the Coalition’s blockade on imports – as well as damage to port infrastructure due to airstrikes –added to the humanitarian burden by preventing commercial goods from entering. When their own medical supplies ran out, like bandages and ointments to treat burned victims, hospitals were not able to procure them from the market as before they were once plentiful but now unavailable due to the blockade. According to the 2017 Humanitarian Needs Overview, more than 90 percent of staple food, such as cereals, in Yemen was imported prior to the war, and the country was using an estimated half a million metric tons of fuel per month before the crisis. Because fuel is essential to distribute food, pump water and run hospital generators, among other critical activities, it is all the more imperative to ensure its free entry into Yemen. In August 2016, OCHA estimated that commercial fuel imports fell to just 24 percent of monthly requirements while food imports hit their lowest level. These restrictions constitute a major driver of shortages and rising prices of basic commodities including medicines, which have in turn contributed to crippling the economy. Health facilities continue to close at alarming rates due to shortages of fuel and other basic supplies and will continue to be the trend if the blockade is not lifted.  Notably so,the ban on commercial and humanitarian flights to and from Sanaa International Airport has prevented Yemenis from seeking health care abroad and exacerbates the pain and suffering of the populace.

Effects of the UNVIM on Commercial and Humanitarian Imports

We are yet to see any significant positive effect of the U.N. Verification and Inspection Mechanism (UNVIM) that was announced by former Secretary General Ban Ki-moon in May 2016. As a positive development, the UNVIM is designed to facilitate the unimpeded flow of commercial goods and services to three Yemeni ports – Saleef, Mokha, Hodeidah and associated oil terminals – while ensuring compliance with the arms embargo imposed by the Security Council.  In effect, the UNVIM replaces the coalition’s blockade with a U.N. mechanism for searching and inspecting incoming ships for weapons, making the process more efficient and thereby helping to alleviate the mass suffering caused by the blockade.

According to the Undersecretary General and Emergency Relief Coordinator Stephen Obrien, the UNVIM has cleared 190 commercial vessels that successfully offloaded three million metric tons of food fuel and supplies at ports in Hodeida, Ras Issa and Saleef but that there are 40 vessels waiting to offload 1.4 million metrics of cargo, 600,000 metric tons of which is food. He further stated that offloading cargo can take up to 30 days because of inefficient port management, financial disputes among shippers and above all slow offloading due to limited capacity at Hodeida port which was severely damaged by airstrikes in August 2015. His recommendation entails the swift removal of damaged cranes to make way for emergency mobile cranes as fuel imports since February 2016 have averaged a fifth of the pre-airstrikes levels. Obrien called on the coalition and local port authorities to ensure rapid and safe access for cleared vessels to reach the ports especially Hodeida port for all potential donors to support the rehabilitation of the damaged Hodeida port, reminding the Security Council that the port is the lifeline of the country.

The Coalition airstrikes on medical facilities and personnel in addition to the blockade on food, medicine, and fuel are measures deliberately inflicted on the Yemeni people that interfere with access to health care services. An independent international investigation is in order in Yemen to assess and quantify the damages caused to the health care sector and other sectors as well, so that the people of Yemen are compensated fully and the perpetrators are held to account. Without a repercussion or consequence in place for violators, medical impartiality will continue to be violated with impunity in an ever increasing manner. In the meantime, the rehabilitation of Yemen’s ports and the lifting of the blockade is needed immediately.

Author: Mohammad Alwazir, Director of Legal Affairs at Arabian Rights Watch Association