Update on 31 October, 2018
Yemen’s cholera outbreak, which has been deemed the worst in the world, is worsening again. According to the latest data from the World Health Organization (WHO), roughly 10,000 suspected cases are now being reported every week, 30% of which are children under five-years-old.
Yemen has seen an increase in the number of cholera cases since June 2018. However, the increase is reported to have been most significant during last three weeks of September, when 185,160 suspected cholera cases were reported.
Save the Children has observed a near tripling of suspected cholera cases in Hodeidah during the span of three months, from June to August 2018. In that time, Save the Children-supported health facilities across the governorate recorded a 170% increase in the number of suspected cholera cases.
The accelerated cholera outbreak coincides with the severe escalation of conflict between the Houthi movement and Saudi- and Emirati-led coalition in June. Between 26 and 28 July, coalition airstrikes damaged a sanitation facility and water station that supply Hodeidah with most of its water. After that incident, suspected cholera cases almost doubled between July and August, from 732 to 1,342 cases.
The governorate is also home to nearly 100,000 severely malnourished children and an estimated 1.1 million malnourished pregnant women who are all at risk and require immediate care. Due to their weakened immune systems, they are far more likely to catch diarrheal diseases like cholera, further worsening their conditions as the disease causes violent vomiting and diarrhea. The disease is especially deadly for children under five–years-old.
Additionally, since the beginning of June, over half a million people have been displaced from their homes in Hodeidah, and forced to live in overcrowded host communities with poor conditions and little access to clean water and sanitation.
A new vaccination campaign is underway in collaboration between the Yemeni government and WHO to prevent a third major outbreak.
As of 21 December 2017, 1 million cholera cases are suspected in Yemen, many of them children. According to estimates, an average of 5,000 people were infected with the disease each day. Since the outbreak began in late April, a total of 2,074 people have died. According to an analysis by the World Health Organization (WHO), roughly 90 percent of cholera deaths occurred in areas under the control of Houthi rebels, where the Saudi-led coalition’s blockade and airstrikes have left civilians more vulnerable to the disease.
The Saudi-led coalition’s closure of Hudaydah port and Sanaa’s airport hindered the delivery of aid from reaching Houthi-controlled areas and prevented thousands of patients from flying abroad for treatment. In early 2015, the coalition bombed Sanaa’s airport, destroying its runway and leaving humanitarian aircrafts unable to deliver aid. The Saudi-led coalition also targeted civilian infrastructure including public water systems. In the past two years, the coalition carried out more than 160 attacks against medical facilities. These attacks aggravated the humanitarian situation in the country, making it difficult to deal with the cholera outbreak. Attacks like the infamous coalition bombing of a Medicines Sans Frontier (MSF) facility in 2016 have forced aid groups to leave the country slowing down the humanitarian response to the epidemic.
Saudi Arabia has accused the Houthi rebels of confiscating medical aid and blocking the delivery of such supplies to civilians, including by mining roads and cutting off access to hospitals. According to Yemen’s minister of local administration and head of the official High Aid Committee, the Houthi rebels “have prevented the humanitarian and medical aid from reaching several governorates which are in urgent need of assistance.” Houthi rebels have also targeted aid ships, including one from the United Arab Emirates.
With the humanitarian crisis reaching new lows in the country, we endorse the UN Human Rights Council’s resolution to mandate a group of international experts to investigate abuses in Yemen. We hope that this intervention will put an end to the impunity of the different conflicting parties involved, and hold them accountable for their acts. We also call on an intervention to solve the deteriorating cholera situation by providing immediate medical assistance to the people of Yemen.
Update on November 24, 2017:
Yemen’s cholera epidemic has slightly improved in the past six months, with the number of suspected cases per day reportedly dropping from 5000 to 2,500 by November 2017. Fatality rates dropped from 0.6% in 2016, to 0.24% since April 2017. This decrease was the result of many factors:
- The strengthening of situational and operational awareness through the continued use of campaigns on national media and social media, in order to engage communities by discussing key practices and messages. Cholera brochures have also been printed and disseminated during house-to-house cholera awareness campaigns. In August, a national cholera awareness campaign was implemented by the Ministry of Public Health and Population with the collaboration of UNICEF and WHO.
- The increased funding of the Yemen Humanitarian Response Plan (YHRP) from 29% in June to 9% in November, especially in the health sector in which the percentage of the funds needed increased from 13.5% to 31.1% by November. This increase boosted the spread of health facilities (health centers and health units) all over the country, and enhanced the health situation in the entire country.
- Ensuring an effective delivery of humanitarian aid through coordination mechanisms: when INGOs operated alone, like Médecins Sans Frontières (MSF), they are sometimes threatened or attacked by Yemeni groups that mistrust their work. Instead, local NGOs, which have greater knowledge of the working environment and Yemeni culture, have begun coordinating with these INGOs, which have more extensive resources, to help them operate effectively in volatile security areas.
These factors, among others, have proven to be highly effective: 11 million people in need of humanitarian assistance have been reached and, by the beginning of November 2017, 62% of people infected with cholera have recovered since the beginning of the outbreak in April 2017.
Yet, despite the partial – if significant – success, MSF is closing the majority of its cholera treatment centers or reducing their capacity, stating that: “it is no longer our medical priority in Yemen”. The weekly number of admissions in MSF cholera treatment centers in Yemen shrank from 11,139 – at the peak of the outbreak – to 567 in the second week of October. MSF’s mission in Yemen is one of the largest in the world and is critical to improving the humanitarian situation. If its capacity is negatively impacted by these closures, it will have serious repercussions for the distribution of aid and medical care in Yemen.
We call for increased funding to the Yemen Humanitarian Response Plan elaborated by the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), because the current proportion of required funding, 31.1%, is not enough to solve ongoing problems. The issue of non-payment of public health workers’ salaries, for example, has been ongoing for over a year and has deeply affected the health system by forcing many doctors, nurses and other health professionals to seek alternative sources of income. Additionally, further resources are necessary to remedy the insufficient delivery of vaccines and medication and to increase the number of people who can access this aid.
Furthermore, we call for establishing a permanent local body that will take over MSF’s duties in Yemen to further improve the situation and to achieve a sustainable response to cholera, as well to prevent other diseases from spreading in the country.