Conflict, Hunger and Disease in
Yemen
Yemen’s civil war, now well into its fifth year with no immediate hope of peace in view, is driving residents of the Middle East’s poorest country deeper into misery.
Already struggling to control communicable disease and chronic malnutrition when the civil war broke out in March 2015, Yemen today is seen as the world’s worst humanitarian disaster. By late 2019, more than 100,000 are estimated to have died as a direct result of the conflict, while another 131,000 are believed to have lost their lives from causes indirectly linked to the war, including starvation and disease.
Children have suffered especially, with an estimated 2 million under the age of 5 acutely malnourished and living in near-famine conditions. A United Nations report in early 2019 concluded: “Yemen now risks losing its youngest generation to a vicious cycle of violence, displacement, poverty and illiteracy.”
In December 2018, talks in Sweden between the warring factions in the country’s long civil war produced agreement in principle to an exchange of prisoners and a limited ceasefire and withdrawal of forces from the embattled port city of al-Hudaydah. Through most of 2019 only limited progress toward these goals have been achieved and fighting continues. Without peace, humanitarian conditions in Yemen are expected to deteriorate further.
Since the spring of 2017, the country has endured the world’s largest cholera outbreak in recent memory, with more than 1 million suspected cases reported in 2017 alone. Between January 2018 and September 2019 more than 991,000 suspected cases identified. Continued fighting has contributed to a general tightening of food, fuel and medical supplies, most of which are imported.
In this challenging environment, International Medical Corps serves areas of Yemen with some of the most pressing humanitarian needs, even though widespread damage to existing infrastructure has restricted access to many areas. More than half of Yemen’s health facilities no longer function and with the government unable to support it, only outside assistance prevents the country’s health system from total collapse.
3.3 million
children and pregnant or nursing women are acutely malnourished
Every ten minutes
a child under five in Yemen dies of preventable causes
50%
of Yemen’s population lacks clean water, sanitation and hygiene services, increasing the risk of infectious diseases
Frequently Asked Questions
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Why are hunger, malnutrition and the threat of famine major issues in Yemen?
Yemen is the poorest country in the Middle East. Historically, it has endured long years of weak, often divided governments that have been unable to provide a secure, politically stable environment or basic social services, such as healthcare, for their people. In addition, Yemen grows little of its own food, relying chiefly on imports. But the cost of this food is also simply out of reach for many Yemenis—especially in rural areas, where bread and rice are the mainstays, supplemented occasionally with vegetables and very rarely with meat. Even in the best of times, poor roads, clogged ports, little government authority, weak purchasing power and only nascent distribution systems combine to make delivering imported food to rural areas a challenge.
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Why don’t we hear more about Yemen if conditions are so desperate?
Yemen lies at the outer fringes of the Middle East region. It is remote, sharing land borders with only two countries: Saudi Arabia to the north and the Sultanate of Oman to the east. It is accessible by air via just one commercial carrier or by sea from Djibouti. Consequently, Yemen is both very hard for journalists to reach and extremely dangerous for them to tell the story of Yemen’s tragedy. And unlike Syria, where another tragic Middle East civil war has unfolded, few of Yemen’s citizens can afford the journey to safety in Europe or elsewhere in the West. Although Yemen’s population of more than 29 million is larger than Syria’s pre-war figure of 21 million, fewer than 200,000 Yemenis are officially listed as refugees, compared to about 5.6 million Syrians.
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Why is Yemen vulnerable to cholera and why was the outbreak there so virulent?
Cholera is endemic to Yemen, but it has been able to take hold in recent years because of the ongoing conflict. More than half of Yemen’s population of 29.3 million now lacks access to proper healthcare and to clean water, sanitation and hygiene services, which leaves Yemenis vulnerable to communicable disease. And as the conflict drags on, the ever deepening economic crisis has caused many more people go hungry—and malnourished children, women and men are much more susceptible to illness. In addition, Yemen’s civil war has further eroded the already limited capacity of the country’s healthcare system to respond to public health emergencies.
The Shadow of Famine
Four and one-half years of war have driven most of Yemen’s 29 million people deeper into despair, with two-thirds of the country’s 333 administrative districts experiencing “pre-famine” conditions while pockets of catastrophic hunger exist in the remaining third.
READ MOREThe Challenges
Ongoing Civil War
War with no end in sight has divided the country, claimed an estimated 100,000 lives directly and another 131,000 indirectly through starvation and disease. The war has also severely disrupted the flow of goods, including fuel, food and medical supplies, most all of which are imported
Weak Infrastructure
Fewer than half the country’s health facilities still function and over 20 million people lack access to basic health care
Restricted Access
Civil war plus the presence of other well-armed militant group and stifling bureaucratic demands all limit access for humanitarian organizations working to deliver food, medicines and other life-saving supplies to those in desperate need
Our Response
Overview
International Medical Corps currently maintains a staff of more than 200 in the country, managing our response from a main office in the capital, Sana’a, with sub offices in Ibb and Aden. From these three offices, we serve communities directly affected by the war in seven of Yemen’s 23 governorates: Sana’a, Amanat al Asimah, Ibb, Taizz, Aden, Lahj and Al Dhalea. We also work to strengthen existing institutions, providing them with supplies and training that enable them to continue functioning.
Healthcare
Drawing from our experience responding to armed conflict and natural disasters in more than 80 countries over the past 35 years, International Medical Corps supports and strengthens local human resources through training to build sustainability, acceptability and easier access to beneficiary communities. Since 2012, International Medical Corps has supported primary and secondary healthcare facilities in seven governorates, enabling them to remain functional and provide a wide range of services, including maternal and child care, sexual and reproductive health, prevention and control of communicable and non- communicable diseases, provision of essential medical commodities and proper waste management. Our use of mobile medical units gives us the flexibility to provide assistance to those reside in remote locations and are unable to reach static services.
Nutrition
In a country where food security has been a challenge even in the best of times, International Medical Corps is implementing emergency nutrition and food security programs to address growing needs in an environment of continued conflict. Years of war have left one of every four Yemenis malnourished.
We conduct community management of acute malnutrition (CMAM) programs and equip health facilities at all levels to provide nutritional support for pregnant and lactating women (PLWs) and malnourished children under 5. We also deliver lifesaving care for severely malnourished children with complications at two in-patient facilities in Sana’a and three in Lahj. When required, we refer children from International Medical Corps-supported clinics to nearby hospitals.
In addition, we support 56 community-level healthcare centers in Sana’a, Taizz, Lahj and Aden governorates by providing training, essential drugs and nutritional supplies needed for outpatient therapeutic and supplementary feeding programs. These programs ensure that acutely malnourished children receive the best possible outpatient care as well as appropriate referral services. We also help health workers provide individual counselling to mothers and caregivers on Infant and young-child feeding practices.
At the community level, International Medical Corps works with community health volunteers (CHVs) to establish support groups where mothers and caregivers can share experiences on infant and young-child feeding and hygiene practices. Our teams ensure early detection and referral of acutely malnourished children and PLWs for specialized care. Our CHVs also trace children and nursing mothers who drop out of treatment or who have been referred but fail to show up for treatment. These volunteers provide families with critical information about the prevention of malnutrition. On average, we reach more than 6,500 individuals per month with health and nutrition education, 80% of whom are female.
Water Sanitation and Hygiene (WASH)
Water, sanitation and hygiene (WASH) is one of the key program pillars of our emergency response in Yemen, focusing on mitigating the increased risk of diseases caused by reduced access to clean water, basic sanitation and hygiene. We provide safe water, promote healthy hygiene practices to prevent the spread of disease, support latrine and water system construction and rehabilitation, and support responsible solid and medical waste management. Since we began WASH programming in Yemen in 2012, we have reached more than 2 million people, providing critical access to water, sanitation and hygiene during major cholera outbreaks over the last three years.
Food Security and Livelihoods
Food security and livelihoods (FSL) is a core component of International Medical Corps’ program strategy in Yemen. In addition to providing conventional food assistance linked with sustainable livelihoods, we have a comprehensive program for food distribution using vouchers specifically for families affected by malnutrition. Our program to replace valuable livestock lost in the fighting helps regenerate wealth and strengthen household incomes. Working with our health and nutrition teams, our FSL team selects recipients of new livestock based on criteria developed in consultation with communities. Technical training on business and financial management is also available to support sustainable livelihoods. Currently, more than 1,300 households are being supported through the livestock assistance program in three governorates.
Capacity Building
Regular training on health, nutrition, WASH, food security and protection issues is a central component of International Medical Corps programming in Yemen, to ensure delivery of quality services in line with recognized standards and protocols. Due to the current humanitarian emergency and the severely weakened government healthcare system, we focus on improving healthcare staff members’ knowledge and skills in services offered at the health facilities we support.
Training on health issues includes integrated management of childhood illnesses, expanded immunization programs, the minimum initial service package (MISP), training for reproductive health, HIV and sexually transmitted disease (STD) prevention and treatment, emergency obstetrics and newborn care (EmONC) training, and infection prevention and control. Nutrition training focuses on all components of community-based management of acute malnutrition (CMAM), and infant and young-child feeding (IYCF) in emergencies. International Medical Corps also trains community-based health and nutrition staff to deliver WASH messages, along with health and nutrition services, to vulnerable Yemeni communities.
Monitoring, Evaluation, Accountability and Learning (MEAL)
International Medical Corps has an MEAL team in Yemen that systematically tracks outputs and outcomes of our programs and gathers beneficiary feedback for continuous improvement. To this end, we have developed District Health Information System 2 (DHIS2), an open-source data collection, aggregation and reporting software package that enables International Medical Corps to have access to timely data, minimize errors and help us make evidence-based decisions related to our programs. Whenever possible, the system captures data or information on interventions, disaggregated by sex, age and deprived groups, including the disabled.
We also use other technical systems, including accountability to affected population (AAP) and community-based feedback and response mechanism (CBFRM), based on the global International Medical Corps CBFRM framework.
Protection Mainstreaming
Protection and gender-based violence (GBV) prevention programming remain the most sensitive interventions in Yemen, both because of the extreme cultural sensitivities that surround them and because they often occur in areas where armed conflict and critical food shortages force communities to focus on survival. To promote protection mainstreaming across all sectors, International Medical Corps employs staff devoted solely to protection mainstreaming, ensuring that interventions are aligned to all applicable international protection standards in the health, nutrition, WASH and FSL programs.
Protection mainstreaming efforts within our Yemen mission are conducted in close coordination and communication with the United Nations’ GBV Sub-Cluster and Protection Cluster in the country. All International Medical Corps program staff, as well as monitoring, evaluation, accountability and learning (MEAL) staff are trained on how to include protection in planned activities. International Medical Corps monitoring tools are designed to capture the key elements of beneficiary protection as set out in approved guidelines.