COVID IN YEMEN:
International Zoom Conference Discusses Challenges
“Resources are limited and cannot cope with the second wave of the COVID-19 pandemic in Yemen. Receiving help in time is critical for us.” That was the message from Dr Qasem Buhaibeh, Yemen’s Minister of Public Health and Populations, who addressed a recent international Yemen zoom conference of health care professionals.
The conference, Yemen Covid 19-response, was organized by Health Professionals for UK, and the Yemen Special Interest Group (SIG), Faculty of Public Health UK to raise awareness of the COVID-19 second wave in Yemen and identify issues and needs facing the Yemeni health system in fighting against the virus.
On April 9th the health minister announced that occupancy in intensive care units in quarantine centres had reached maximum capacity because of a sharp increase in the number of cases. On May 7th cases of COVID-19 totalled 6,426 and deaths 1,265. This is likely to be an underestimate owing to a severe lack of testing facilities and the questionable reliability of figures from the government and the Houthis who control most of the north of the country. The mortality rate of 27 per cent is one of the highest in the world and five times the global average.
One of the greatest challenges in fighting COVID-19 is the collapsing healthcare system which is buckling as the coronavirus pandemic hits an infrastructure already devastated by more than six years of war. The ongoing conflict means that many cases are untraceable. Researchers at the London School of Hygiene and Tropical Medicine forecast that as many as 11 million could be infected, leading to 62,000-85,000 deaths. A report from the non-governmental organization MedGlobal and the Center for Global Health at the University of Illinois, USA said that 97 healthcare workers had died from COVID-19, citing data collected by medical students and local doctors. Around 18 per cent of the country’s 333 districts have no doctors, and many of those who are still working have been unpaid for nearly two years. MedGlobal said that there were now 10 healthcare workers for every 10,000 people, less than half the World Health Organization benchmark.
All the speakers who addressed the conference drew attention to the shortage of medical and PPE equipment, lack of IC beds, lack of trained IC staff, the threat from other diseases such as cholera and diphtheria, malnutrition, food insecurity and the problem of Internally Displaced People with a weak immune system who are at great risk of contracting COVID-19.
The first wave of the virus affected Yemen from April to August 2020. On April 10th 2020, Yemen recorded its first laboratory-confirmed COVID-19 case in the Southern governorate of Hadhramaut. By the end of May, cases and deaths had been reported in the governorates of Aden, Taiz, Lahj and Sanaa. By June 2020 coronavirus spread across the country, pushing Yemen’s ruined health care system to the brink.
Many hospitals closed for fear of the virus, or for lack of staff and personal protective equipment. The second wave started in March 2021 on the sixth anniversary of the start of the civil war. The recorded cases of Covid in the first two weeks of March were 22 times higher than the number of cases in the first two weeks of February. On March 31st the Internationally Recognized Government declared a health emergency in the areas under its control.
Dr Buhaibeh told the conference that in Aden and the southern governorates there are 16 isolation centres. “We started to provide them with equipment but resources are limited and we cannot cope with the second wave of the pandemic. We have a shortage of trained qualified IC staff. Because of the war many of our qualified Yemeni doctors travelled abroad or went to work in private clinics attracted by good salaries. We have shortage in the IC equipment and we have shortage in oxygen. There is also a major problem in IDP camps in Marib where there are limited facilities. Yemen is also receiving many refugees from Somalia with weak immunity.”
Some two million people are internally displaced in Yemen, according to the latest figures from UNHCR. Nearly 90 per cent of those uprooted have been displaced for more than a year. The UN estimates that some 24 million people in Yemen—nearly 80 per cent of the entire population—require some form of humanitarian assistance and protection. There are 125 camps and between one and three million displaced people in the Marib area, but already 15,000 people have been forced to leave and the camps since fighting began in the region in February.
Dr Adham R Ismail Abdel-Moneim, the WHO representative to Yemen, said that most of the reported cases of COVID-19 are in the south of the country, home to 30 per cent of the population. There are no reports of the number of cases from the north. Last December WHO conducted a survey in Aden by collecting samples from almost 2,000 randomly selected individuals. In Aden with a population of one million 27 per cent already had antibodies. Almost 250,000 have been infected from the first wave.
Dr Abdel-Moneim also spoke about major funding problems. Six million dollars are needed to respond to the cases on the ground. “At least $3 million is needed in the coming months - $2 million are needed in June and July and the remaining $1 million is needed before September. The Saudi Development Bank, the Korean government, the King Salman Relief Fund, the UN organisation OCHA and the World Bank have contributed generously but we need to mobilise new donors.”
Professor Maha El Rabbat, the WHO’s Special Envoy on COVID-19, emphasized the need for proper public health measures. “The stopping of activities is only for a certain period. But this is not a long-term response or intervention. The communities have to be empowered to work for the benefit of the country. We need to involve the people themselves. It is not just the government that has to respond. The whole society has to respond.”
Professor Neil Squires, International Registrar for the Faculty of Public Health said that the faculty has a Yemen Special Interest Group. “We work on advocacy against cuts in the aid budget which has led to a reduction in humanitarian support. This is having a real impact on Yemen. Our collective voices need to be raised against this. We need to promote the equitable distribution of vaccines to make sure that all countries particularly the poorest and most vulnerable have access.” This year the UK has pledged at least £87 million, down from a promise of £160 million in 2020 and £200 million in 2019.
Professor Squires drew attention to the fact that some health workers in Yemen have not received salaries. “They are working in remote in and difficult situations. It is difficult for them to get access to learning and development materials in order to maintain professional standards. Members of the faculty have been working to try to identify ways in which we can continue to support our professional colleagues and build peer to peer linkages which are incredibly important. Individual health workers appreciate one to one communication and it can really lift their spirits in the absence of any external reward.”