SANAA, 11 January 2012 (IRIN) - Unrest in Yemen for almost a year has affected the government's capacity to function, forcing aid agencies to work more closely with, and through, community-level partners and volunteers, says a senior aid worker with the UN Children's Fund (UNICEF).
"The government commitment at the central level [line ministries] to allocate resources and implement and monitor routine activities is inadequate; the capacity of decentralized government institutions to fulfil their obligations is very weak," said Geert Cappelaere, a UNICEF representative in Yemen.
Across the Middle East, aid workers have complained of the challenges of effectively designing and executing programmes while political instability surrounds their national counterparts, due to mass anti-government protests which have swept the region since the beginning of last year. In Egypt, ministers change every few weeks and in Libya, the interim government has been hesitant to take action on certain issues, preferring to leave long-term decisions to an elected government.
"There are very few implementing partners [in Yemen], with extremely limited capacity to operationalize and manage outpatient therapeutic centres," said Cappelaere.
Only 50 percent of outpatient treatment centres in 14 out of 21 governorates were operating at the end of September 2011, due to insecurity, fuel shortages and civil unrest, UNICEF said in a 7 January report.
Protests against leaders of dozens of national institutions since mid-December have made the situation worse, reported local weekly Yemen Times.
"The role of these institutions has been undermined by lack of funding as a result of the year-long unrest. Currently they are paralysed by mass staff strikes and protests," said Abdruhman Abdulhamid, an adviser to the minister of planning and international cooperation.
In the absence of strong and reliable central government support in fighting high levels of malnutrition, aid workers are working closely with community health leaders.
Community Management of Acute Malnutrition (CMAM), which enables communities and lower level health facilities to treat the vast majority of cases and reserves in-patient care for only those with critical complications, is being successfully promoted by international and local NGOs, according to Saja Abdullah, nutrition cluster coordinator at UNICEF.
"Through CMAM, a mother brings her severely malnourished child to the nearest health facility for assessment and life-saving intervention in the form of medicine and therapeutic food," Wisam al-Timimi, a UNICEF nutrition and child survival specialist in Yemen, told IRIN.
CMAM was first initiated in Yemen in 2008 with only three operational health facilities, but now operates in 374 health centres in 17 out of Yemen's 21 governorates.
"These facilities provide under-five severely acute malnourished cases with antibiotics, plumpy'nut, different vitamins, supplements, and deworming tablets, as well as double-check the vaccination status of a referred child. If a child is missing a vaccine, he or she will be given this vaccine," al-Timimi said.
Between January and November 2011, 58,338 children under five with severe acute malnutrition (SAM) were treated in 374 CMAM facilities, according to a UNICEF report released in mid-December.
"Now our plan is to treat 105,000 severely acute malnourished under-five children by the end of 2012 through operationalizing at least 660 health facilities to deliver CMAM services country-wide," al-Timimi told IRIN.
Mohammed Audha, an operations officer with local NGO al-Saleh Foundation for Social Development, told IRIN that given the limited role being played by the authorities, local knowledge about the security situation was vital for effective needs assessments and aid delivery.
"Last month we cancelled an aid convoy heading for al-Jawf Governorate after it already left Sana'a when local coordinators advised us by phone against going to the governorate due to clashes between Houthi fighters and armed tribesmen from the Islamist Islah Party," he said. "The aid was returned to our warehouses in Sana'a."
"Community-based volunteers are more aware of the vulnerable cases. They also know which roads are safe, and the most appropriate time for delivering assistance. They know how to avoid risks posed by gunmen," Essam Awadh, an emergency officer with local NGO Charitable Society for Social Welfare (CSSW), told IRIN.
Local volunteers can be an asset at illegal checkpoints on highways and particularly in remote areas.
"If you have escorts from the local community, you become less prone to risks by gunmen at checkpoints," said Fatihya Abdullah, an aid worker with local NGO Yemeni Family Care Association.
"Local people know the whereabouts of gunmen at these illegal checkpoints, which is why the latter don't dare to intercept them or loot aid being delivered," she added.
Local people are the ones who best know the needs of their communities and the geography. They can also often assist in the organization of distributions, help cross-check lists of beneficiaries, control the crowds and speed up the delivery of assistance to those in need, said Rabab Al-Rifai, communications coordinator for the International Committee of the Red Cross (ICRC) in Yemen. "People from a given community enlighten us on important cultural aspects; this enables us to have a better understanding of the required assistance, adapt our humanitarian response, and respond to the needs in a manner that is respectful to the local culture", she told IRIN.