Yemen is in the grip of a fast spreading cholera outbreak of unprecedented scale. This plan presents an integrated response to the significant upsurge of acute watery diarrhoea (AWD)/suspected cholera cases across the country, since 27 April. Consequently, as of 28 June, a total of 254,871 suspected cases, with 1,439 associated deaths (0.6% CFR) were reported from 286 districts (20 Governorates). On 14 May, the MoHP declared a state of emergency stating that the health system is unable to contain this unprecedented health and environmental disaster. An additional, 280,358 cases are projected from the high risk districts in the coming six months till end of 2017.
The plan outlines emergency health, WASH and communications interventions to contain and prevent further spread of the outbreak in the 286 high risk districts, where suspected cholera cases were reported during the period October 2016 to June 2017 (see Annex 1 for details). Health and WASH clusters will continually identify priority districts from high risk districts, by considering the number of cases and attack rate.
A total of $ 254 million is required to implement activities outlined in this integrated plan for 6 months from May to December 2017, to control the outbreak, prevent further spread, and minimize the risk of recurrence. Considering available resources, including almost $50 million allocated through YHPF, WB, China and KSReleif, the net requirement totals to $207 million.
1. OVERVIEW OF THE CHOLERA OUTBREAK
The Yemen’s Ministry of Public Health and Population (MoPHP) confirmed a cholera outbreak in Amanat al Asimah Governorate in October 2016. Subsequently, the outbreak spread to close to 165 districts in 16 Governorates by the end of December 2016. The trend of the cholera outbreak and case-fatality rate then declined during the period January to March, with the number of districts reporting suspected cholera cases dropping to 25. The decline in the epidemic curve could be partly attributed to the health and WASH interventions. A total of 24,504 suspected cases, including 143 associated deaths (with a case-fatality rate of 0.44%) were reported by the end of March 2017.
The resurgence of the outbreak during the last week of April resulted in a cumulative of 254,871 suspected cases, with 1,439 associated deaths (0.6% CFR) by 28 June, rapidly spreading to 286 districts (in 20 governorates). With the rapid spread, the cumulative number of cases during the seven weeks period is six times more than those reported over a period of the first months in the October 2016 outbreak.
The outbreak is spreading against the backdrop of a major humanitarian crisis. The current upsurge of cholera cases is attributed to prevalence of risk factors including disruption of public health and WASH services amidst increasingly collapsing basic services, displacement, and inadequate sanitation conditions. Less than 45 per cent of all health facilities are fully functional and more than 8 million people lack access to safe drinking water and sanitation.
The situation is further aggravated by high prevalence of severe food insecurity and malnutrition. The health condition of this vulnerable population is already compromised by the deteriorating situation, increasing their susceptibility to cholera infection and associated complications contributing to higher case fatality rate. Two years of conflict, compounded by an economic decline have devastated livelihoods, depleted safety nets, weakened social service delivery, and ability to access social services.
Health and WASH clusters immediately mobilized partners to scale up response. Two emergency operations centres have been established in Aden and Sana’a to oversee surveillance activities and coordinate the response. As of 28 June, 2,351 CTC beds have been established to treat severe cases. Additionally, 311 community-level Oral Rehydration Points (ORPs) were opened in Sana’a and other affected governorates to treat moderate and mild cases, with a referral system of severe cases to the CTCs. Over 5 million people benefitted from chlorinated water supplies (at system and household levels), more than 2.5 million people benefitted from water storage disinfection (both at community and household levels). Almost 2 million people were reached with key cholera messages, through household, community and mass media campaigns. Water, sanitation and hygiene related activities took place in 165 districts in 18 governorates. Partners are re-programming resources to respond to the outbreak.
Despite these, the spread of the outbreak continue to outpace ongoing response efforts, and additional resources are required to scale up interventions to control the outbreak and prevent further spread.