Saturday, August 8, 2020

Yemen's Multilayered War: The Failing Healthcare Infrastructure

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Anant Jani

Article Title

Yemen's Multilayered War: The Failing Healthcare Infrastructure

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Global Views 360

Publication Date

August 8, 2020

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Air strike Al-Thawra hospital, Hodeida on August 2, 2018

Air strike Al-Thawra hospital, Hodeida on August 2, 2018 | Photo credit: ABDO HYDER/AFP/Getty Images | Source: Felton Davis via Flickr

This is the 6th and last part of a short explainer article series on the current crisis in Yemen. To read the earlier parts of the series click on the link.

To read the 1st part of the series click on the link.

To read the 2nd part of the series click on the link.

To read the 3rd part of the series click on the link.

To read the 4th part of the series click on the link.

To read the 5th part of the series click on the link.

The civil war in Yemen, more so after 2015 has taken a toll on the civic infrastructure of the already fragile and poor country. Among these, the healthcare infrastructure of the country was one of the worst affected.

Apart from the physical damage to the hospitals and clinics due to the aerial bombings by the Saudi Arabia led coalition, the naval blockades exacerbated the dire situation. In June 2015 itself, aid agencies warned of the humanitarian risks brought by the US and UK-backed Saudi blockades.

The humanitarian situation aggravated further as there was a consistent famine since 2016 and Yemen was dependent on foreign aid for feeding almost 80% of its population.  According to UNICEF reports, over 3.3 million children and pregnant or lactating women suffer from acute malnutrition.

In 2017, the World Food Programme estimated that an additional 3.2 million people would be pushed into hunger. If left untreated, 150,000 malnourished children could die within the coming months.

Save the Children, the international charity and aid agency, estimated that 85,000 children under the age of five have starved to death in between 2015 to 2018.

Major healthcare operatives are dying due to the active bombing and conflict in Yemen, including personnel from MSF and United Nations Office for Coordination of Humanitarian Affairs (OCHO).

The MSF (or Doctors Without Borders), who have been in Yemen since 2007, have reported that fears of stigmatization are causing people to stay away from hospitals, with misinformation and lack of medical services only compounding the healthcare issue during the pandemic.

As of 24th July, the country reports 1640 confirmed infections and 458 related deaths.  Al Jazeera reported that “Cemeteries in Aden are overflowing with graves, suggesting that the number of people killed by the new coronavirus is higher than the official count.” Yemen and its related aid agencies also suffer from lack of PPEs and adequate information about the pandemic.

As of April 2020, there are 800,000 internally displaced persons in just one province of Yemen Marib. The number of verified civilian deaths stands at 7,700.

The United Nations has been continually asking for donations, but has failed to collect as much as it requires. While it collected $4 billion last year, it has only received $700 million, halfway into 2020.

The UN urged for $2.4 billion this year to fight the humanitarian crises and the Coronavirus. As of 2nd June, 29 countries and the European Commission pledged a total of $1.35 billion to support humanitarian efforts in Yemen, just over half of the amount needed to sustain programs through the end of this year.

In April 2020, the Saudi deputy defence minister, Prince Khalid bin Salman, said Saudi Arabia “will contribute $500m to the UN humanitarian relief program for Yemen in 2020, and an additional $25m to help combat the pandemic. It is up to Houthis to put the health and safety of the Yemeni people above all else.”

There are 41 major UN programmes in Yemen, and it is estimated that more than 30 of them will close due to lack of funds. The UN stated, “Due to the COVID-19 suppression measures, all integrated outreach activities, which include the Expanded Programme on Immunization, Integrated Management of Childhood Illness, Maternal and Newborn Health,and nutrition activities, were suspended.”

Most of Yemen's 3,500 medical facilities have been damaged or destroyed in air strikes, and only half are thought to be fully functioning. Officials warn that monetary relief may not be enough to assist in the war against the pandemic alongside the Civil War. A solution to the war must be found soon, before the pandemic eviscerates more of the healthcare infrastructure.

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February 4, 2021 4:43 PM

Sweden’s No Lockdown Policy: How That Changed The Outcome

Sweden has gone against conventional wisdom in its response to the COVID-19 situation. While the neighbouring countries like Denmark, Finland and Norway imposed strict lockdown on the places and services frequented by the public, Sweden has chosen to not do so at all during the initial phases when COVID-19 started taking the shape of a worldwide pandemic. The public places like Cafes, restaurants, gyms, malls, playgrounds, ski slopes and some of the schools were kept open all across Sweden.

The country’s fight against the threat of pandemic was handled exclusively by the Public Health Authority, with no political interference. They believed that a lockdown only serves to delay the virus, which is not necessary since the health services are equipped to deal with the cases. They also made it clear that achieving herd immunity is also not their aim. The public authorities in Sweden instead relied on the public's sense of responsibility, and appealed to them to do frequent hand washing, observe social distancing and keep people over 70 years old from going out.

The state epidemiologist, Anders Tegnell, made multiple statements about the state’s unusual approach, such as 1) “Once you get into a lockdown, it’s difficult to get out of it,”, “How do you reopen?  When?” 2) “There is no evidence whatsoever that doing more at this stage would make

any difference. It’s far better to introduce stringent measures at very specific intervals, and keep them running for as little time as possible” , 3) " As long as the healthcare system reasonably can cope with and give good care to the ones that need care, it's not clear that having the cases later in time is better”.

The assumption of public responsibility did not work for Sweden and there were people out on the streets, in cafes, restaurants and playgrounds. Not wearing a mask was the social norm instead of the reverse. The models for charting the virus spread given by the concerned authorities also turned out to be faulty forcing them to rescind it. Over 2000 Swedish researchers and doctors signed a petition which claimed that there was not enough testing,tracking or isolation in the country. They believed that the authority has clearly not planned their response and that the authority’s claim for herd immunity has very little scientific basis, even though the government has repeatedly claimed that herd immunity is not what they were aiming for.

Sweden’s lax approach to the combating of coronavirus forced its neighbouring Scandinavian countries to close the border for the Swedish citizens. Some of the Swedish officials were worried for the possible harm to the long term relations between Sweden and its neighbours.  Also, the plan of letting life go on as usual to avoid the economic recession occurring due to a lockdown also failed as it didn’t shield  the country from economic slowdown.

Here comes the question; was the lockdown successful or not? There are some comparisons that have been drawn which indicate more deaths per 100,000 people than in nearby countries with homogenous population, even though it is significantly lesser than some of the European countries. While the infections rates are double that of Denmark, the death rates in comparison are much higher. This difference has been attributed to the fact that approximately half of these deaths have occurred in old care homes despite the stated priority of the officials to protect the elderly. This has been in part to the volunteer program, which replaced symptomatic old age home cares with new volunteers, hence increasing exposure. Another factor is the lack of protective equipment in such homes, along with laws preventing administration of medical procedures without the presence of doctors. There were reports of people threatened with lawsuits for banning visitors.

All of this led to Mr.Tegnell claiming that the ideal policy would have been something between what Sweden adopted and what the other countries did, in the light of what they know now. However this claim of Mr.Tegnell will be put to test when the second wave comes, later in time.

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