Urgent Action Needed to Avert Humanitarian and Health Catastrophe in Yemen

Report
from Safeguarding Health in Conflict
Published on 17 Dec 2018 View Original

In April 2018, UN Secretary-General António Guterres referred to Yemen as “the world’s worst humanitarian crisis.”

Three and a half years of conflict in Yemen have led to the near total collapse of the country’s health system. More than half of health facilities are no longer functional and 16.4 million people do not have access to adequate health services.

Twenty-two million people require humanitarian assistance and 14 million people are on the brink of starvation.

An air, land, and naval blockade imposed by the Saudi and Emirati-led Coalition (SELC) has prevented medical evacuations and the import of crucial medical supplies and fuel to run hospital generators. The economy is crumbling, Yemeni’s face a dire lack of access to food and clean water, and parties to the conflict continue deliberately or indiscriminately attacking health facilities and health workers.

The SELC has bombed urban areas, destroying much of the health system, as well as water and sewer facilities, while the Houthi rebels have also attacked and occupied health facilities.

Civilians have endured an average of 14 airstrikes a day for more than 1,300 days and heavy shelling on the ground. The United States, the United Kingdom, and France have continued supplying weapons to the SELC, with the US providing operational support in the form of refueling and intelligence, until announcing to discontinue refueling on November 10.

Attacks on Health Facilities and Workers

By the end of 2017 more than 55% of the country’s medical facilities had closed. Parties to the conflict have damaged medical facilities and injured or killed health workers in what may have been collateral damage; however, parties to the conflict have also directly targeted medical facilities and personnel. In 2017, the Safeguarding Health in Conflict Coalition reported at least 23 attacks on health workers and facilities, and at least 76 incidents of denials of humanitarian access. Between January and October 2018, there were at least 40 attacks on medical facilities and personnel according to preliminary data from Insecurity Insight, a member of the Safeguarding Health in Conflict Coalition. In one of these attacks, on September 8 in Sirwah district, SELC forces killed three paramedics while they attended to injured motorcyclists. In another incident on July 11, SELC forces destroyed a patient ward, and damaged an adjacent unit of a Médecins Sans Frontières cholera treatment center in Abs, despite it being clearly marked as a medical facility. There were no casualties but MSF temporarily froze activities in Abs until the safety of staff could be guaranteed.
Health workers are not only under constant threat of being attacked, tens of thousands haven’t been paid in months. The attacks on health facilities and indiscriminate attacks in civilian areas over the course of years are blatant violations of international humanitarian law and, when carried out in such a widespread manner, may amount to crimes against humanity.

Cholera

Between April 2017 and October 2018 there were 1.2 million suspected cases of cholera, and 2,515 deaths. Attacks on health facilities and workers, as well as on water supplies, have directly contributed to the cholera outbreak. In July 2018, World Health Organization Director-General Tedros Adhanom Ghebreyesus and World Food Programme Executive Director David Beasley warned of the dangers of the “vicious combination” of cholera and malnutrition. With over 60% of Yemen’s people not knowing where their next meal will come from, malnutrition would make people more susceptible to cholera, and cholera would contribute to malnutrition.

Malnutrition

As the Yemeni Rial currency has dropped, and food prices have nearly doubled, UN Under-Secretary-General for Humanitarian Affairs Mark Lowcock warned in October 2018 that around 14 million people, roughly half the population, were facing “prefamine conditions.” The SELC has helped create famine-like conditions through the blockade, and undermined the ability to address severe malnutrition by tactics of war that have destroyed or led to the closure of medical facilities. The Houthis have also helped create this catastrophe by attacking or occupying medical facilities, and obstructing humanitarian aid. Yet, both parties continue to employ the same tactics. On November 20, Save the Children released a report stating that “an estimated 85,000 children under the age of five may have died from extreme hunger or disease.” The report highlights the challenges faced by foreign assistance agencies in navigating naval blockades, passing military checkpoints, and distributing food, reporting that in November 2018 in just one district, parties to the conflict carried out at least five attacks on vehicles transporting food.