Regular Press Briefing by the Information Service, 19 May 2017 - Yemen
Christian Lindmeier, for the World Health Organization (WHO), introduced Dr Nevio Zagaria, WHO Yemen Country Representative. Speaking by phone from Yemen, Dr. Zagaria said that on 18 May, 3,460 new cholera cases and 20 more deaths had been reported in that one day only. The total of reported cases in the past three weeks in Yemen was of 23,425, and 242 deaths. The disease had spread in 18 of the 23 governorates. The case fatality rate of around 1 per cent was misleading because there were geographical pockets with very poor access to health services, where case fatality reached 4 to 5 per cent as patients reached health facilities very late. Specific age groups, like the population over 60 which represented more than 25 per cent of the overall case load, also had a case fatality over 4 per cent.
A cholera epidemic had started in October 2016, had peaked in December and then had shown significant reduction, but had never been fully controlled. The resurgence of cholera coincided with the rainy season, the further deterioration of the economic situation and the collapse of the health system, with most health workers not receiving salaries over the past six months. That was combined with clear vulnerabilities and attitudes of the population in relation to cholera with roots before the conflict. People had the tendency to go directly to the hospital, while hospitals were completely overwhelmed and congested, instead of having home-based oral rehydration therapy started immediately and then go to the oral rehydration points.
In the first three weeks of the outbreak, WHO worked hand in hand with UNICEF and all the health cluster partners to set up new cholera treatment centres with beds, within hospitals or within temporary structures outside of hospitals, and oral rehydration points. There were now 50 cholera treatment centres operational in the country, and around 300 oral rehydration points. But those numbers were not sufficient to deal with the resurgence of the cholera epidemic.
Looking at the new data released this morning (see above), Dr Zagaria said that the speed of the resurgence of the cholera epidemic was unprecedented compared to what had been seen previously in Yemen. Factors contributing to this were the very severe economic situation, and the fact that electricity was not functioning, so the water pumping stations were functioning in an intermittent way. The sewage system was damaged and the population was using water that was not decontaminated. The cholera epidemic already had pockets with person to person transmission.
The overall humanitarian response was being coordinated by the humanitarian coordinator. WHO would release an emergency response cholera plan in the coming 48 hours. There was an underfunding of the health and water and sanitation sector. There was a need to work together for an integrated response and scale up operations on the ground.
Asked about the emergency response plan to be launched, Dr Zagaria said the plan would entail a reinforcement of the health education campaign at all levels, as well as community mobilization, and a scaling up of the number of cholera oral rehydration points and cholera treatment centres. WHO had a target of 350 cholera treatment centres and 2,000 oral rehydration points, and was covering around 10 to 12 per cent of that target at the moment. WHO was also improving further the surveillance system and the quality of reporting to identify the areas from which the patients came. WHO was supporting the local authorities to increase the number of data managers to provide timely information to international and national NGOs. This part of the work was in real need of funding and scaling up. The spread of the disease was such that the authorities needed substantial support to rehabilitate the sewage system, treat and chlorinate the water sources, and in terms of a social mobilization campaign which needed to reach many more people with different methods: not only TV and media, but also house-to-house visits in remote areas. Support to health workers was also necessary, and it was not possible to respond to the emergency without addressing the issue of the payment of their salaries.
Asked about worries about a potential attack on the port of Al-Hudaydah, Dr Zagaria said that access to the port was currently limited but not interrupted. The medical supplies in the country were already depleted. WHO had organized a cargo of 80 tons of cholera medical supplies and IV fluid to be distributed inside the country. That aspect needed to be factored in: the cost of the operation in Yemen was extremely high, also due to the very difficult logistical situation. It was necessary to rely more on aid operations because of lack of time, poor stockpiling inside the country and the difficulties in accessing ports such as the one of Al-Hudaydah.
Dr Zagaria added that given that there was no information out of some areas, the situation may be even worse than portrayed. The resources to beef up and reactivate the health system in order to deliver services to the population were lacking. WHO had made clear that any patient going to a health facility in the case of this epidemic must have completely free access to health care. The international community needed to be more flexible and in this emergency, to open the door to the payment of incentives to health workers as well as their salaries. Even in areas close to the frontline it was necessary to rely more on the network of community volunteers and social mobilization in order to detect cases early as mortality was widely due to cases being detected and arriving at the hospital late.
The population of Yemen was not at 29,600,000 people. WHO had predicted that it expected 150,000 cases as part of this epidemic, but if transmission went on at this speed the figure would need to be revised to over 200,000 – 250,000 over the next six months, in addition to the 50,000 cases which had already occurred. With these numbers, the price to pay in terms of loss of life would be very high.
Asked about the difference between cholera and acute watery diarrhoea, Mr. Lindmeier said that the presence of the bacteria vibrio cholera needed to be confirmed for the cases to be confirmed as cholera cases. Normally when cases were found, they were all treated as cholera even if there was not a laboratory confirmation. But cholera was a specific type of acute watery diarrhoea.
Babar Baloch, for the United Nations Refugee Agency (UNHCR), said that as the bitter conflict in Yemen continued, the pressure was also mounting on refugees who had gone to the country. Currently, there were about 280,000 refugees in Yemen. Their situation was worsening and their needs and vulnerabilities were growing by the day. The overwhelming majority of refugees in Yemen, 91 per cent or some 255,000, were Somali refugees who had been coming to the country since the early nineties.
Yemen had traditionally been very generous in accepting those in need of international protection and was the only country in the Arabian Peninsula signatory to the Refugee Convention and the Protocol, but the ongoing war had limited the capacities to provide adequate assistance and protection to refugees.
UNHCR was receiving an increasing number of refugees approaching the Agency for assistance to support their return to Somalia, citing safety and security concerns and limited access to services in Yemen. Some 30,600 Somalis have reportedly already returned to Somalia from Yemen since the beginning of the current war. UNHCR was now providing some support to those choosing to return on their own. In 2017, UNHCR would be able to assist up to 10,000 Somali refugees who had made the choice to return, based on the information received at Return Help Desks on conditions in Somalia and the assistance package that was being offered both in Yemen and Somalia. UNHCR assistance would include documentation, travel and transportation assistance and financial support in Yemen to facilitate the journey, as well as assistance upon arrival in Somalia.
Joel Millman, for the International Organization for Migration (IOM), added that IOM had also been working on removing stranded migrants from Yemen. In 2017 IOM had helped evacuate 431 migrants by sea from Al-Hudaydah to Djibouti, with the help of the Federal Republic of Germany's Ministry of Foreign Affairs, and the US State Department's Bureau of Population, Refugees and Migration. Also, IOM staff in Yemen had met with a high-level delegation this week to discuss working on the cholera outbreak and also providing shelter for stranded migrants.