Yemen

A presentation of “Complicated Delivery: The Yemeni mothers and children dying without medical care” written by Medecins sans Frontières (MSF) offers an insight into healthcare inaccessibility in Yemen.

 


From November 2018 to February 2019, MSF collected data by using health indicators from 2016-2018 MSF medical reports. They also conducted ten semi-structured interviews with patients, caretakers, and medical facility staff in MSF’s Taiz Houban Mother and Child Hospital and MSF supported hospital in Abs Hajjah. Although the findings of the report are not representative of the entire country, but its recommendations are applicable nationwide.

The war in Yemen escalated in 2014 when the Houthis Shia rebel group took control of the capital, Sanaa, forcing President Hadi into exile. In order to restore public order and bring the power back to the government, in March 2015, the Saudi and Emirati Coalition (SELC), backed by the US, UK, and France, began aerial strikes on the Houthis. This intervention resulted in increased violence which has made the poorest country in the Middle East even more fragile.

“[B]etween 2016 and 2018, there were 860 deaths of reported in Taiz Houban – 17 mothers, 242 children and 601 newborns. Of these deaths, 227 were children and newborns who were dead on arrival,” with the number increasing every year. As of March 2019, no public hospital in the Taiz governorate has been fully functioning, however, with the support of MSF and other international non-governmental organizations (INGOs), three of the five hospitals in Taiz city centre remain partially open. In the Hajjah governorate, mothers have to travel long distances to receive care, which is worsened by the mountainous character of the terrain surrounding the district of Abs.  As MSF’s Taiz Houban hospital manager describes, sometimes patients cannot travel because of violence and “women are waiting until the last minute to make the dangerous journey to receive care,”. Medical complications during pregnancy become very deadly and infants need high-level newborn care. In Abs Hajjah, “the facility recorded the deaths of 705 people – 19 mothers, 269 children and 417 newborns. Among the 417 neonates, 106 died on the day of arrival between 2016 and 2018.”

Additionally, economic vulnerability leads to high mortality rates and limits the freedom to choose medical facilities. In Yemen, purchasing power is 148 percent lower than in pre-crisis period and although private healthcare was not free and sometimes unavailable in rural areas , it was affordable for many people with regards to transport and financial means. Separately, while public workers have received partial or no salaries since August 2016, payments resumed in 2018 if workers were employed under an internationally recognized government.Currently, because most medical facilities remain private, with high costs of treatment,  most patients choose free MSF facilities which are not always accessible to civilians living in rural areas or on the frontlines.  

Traveling to medical facilities is dangerous, especially for those crossing the frontlines. There is often a lot of violence and tension at the checkpoints controlled by different warring parties. Eftekar, a patient from Ibb governorate recalls: “The road from home to the hospital is not safe. In the past, we can take pregnant women to the hospitals at night but now we cannot... there is a risk we will be shot. Movements are allowed only from 6 am to 6 pm.”

MSF arrived at five recommendations that all actors should follow in order to save lives and so that International Humanitarian Law (IHL) is not violated:

  1. All parties in conflict must cease attacks on medical facilities and respect the protected status of civilians, and medical and humanitarian staff.
  2. There must be a clearer and faster way for humanitarian staff to enter Yemen.
  3. Humanitarian organizations should increase efforts to ensure that staff is specialized and experienced in order to provide quality and timely care.
  4. The bureaucracy should not impede upon the transport of lifesaving drugs and devices. 
  5. Access to humanitarian services in rural and district-level areas.

To learn more, visit:

https://www.msf.org/complicated-delivery-yemeni-mothers-and-children-dying-without-medical-care

https://www.bbc.com/news/world-middle-east-44466574

 

Author: Giulia DeLuca; Editor: Aleksandra Krol