Yemenis must not be forgotten in this pandemic
March 26 marked five years of war in Yemen, a grisly milestone that will barely register as the world grapples with the realities of the coronavirus pandemic.
While no country is immune to the virus, the war has left Yemen at perilous risk; it has decimated an already fragile health system, displaced 3.3 million people, and left 80 per cent of the population in need of humanitarian assistance. With conflict flaring up again across the country, Yemen needs international support now more than ever to prevent the crisis from plumbing to new depths.
At the time of writing there are no confirmed cases in Yemen. However, it has reached Saudi Arabia, Oman and the UAE, countries with which it shares borders. In East Africa from where tens of thousands of migrants still travel to Yemen in an effort to find jobs in Saudi Arabia, cases of communal transition have been documented.
In response, the Houthi authorities in north Yemen have closed borders, and flights between the north and south and into Yemen have been stopped. Despite these steps Yemen’s borders remain porous.
I recently visited Yemen, and saw first-hand how five years of war has devastated its health system, collapsed the economy causing fuel prices to skyrocket and drive up operating costs for hospitals and clinics.
The breakdown of the civil service has left many public sector health workers unpaid for years leaving facilities understaffed. New analysis shows health facilities have been targeted 120 times by warring parties since 2015, in blatant violation of international humanitarian law. The result: nearly half of Yemen’s health facilities are non-operational, leaving 19.7 million people without access to basic healthcare.
Disease surveillance systems are also unprepared – of the 244 people entering Yemen identified for self-isolation due to coronavirus, 100 are already uncounted for. In 2019, Yemen was ranked 179th out of 195 global health systems for its ability to detect and report epidemic outbreaks, 184th for its ability to respond and 193rd for its laboratory testing capacity.
Recent disease outbreaks in Yemen give reason for foreboding. Last year the country was gripped by outbreaks of measles and diphtheria. A cholera outbreak on an enormous scale resulted in almost half a million cases. This year, dengue fever has ripped through the population. These diseases thrive where health systems are weak and populations vulnerable. Countries like China, Italy, the US and the UK are struggling to cope despite advanced health systems; coronavirus will devastate Yemen.
The crippled health system isn’t the only threat: Years of war have also undermined food security. In Yemen I saw IRC teams responding to emergency levels of malnutrition – a condition known to compromise immune systems. For the 20 million Yemenis considered food insecure and the 7.4 million children who require nutritional assistance, COVID-19 poses a major risk.
And for a population already traumatized by years of war, lack of information about the coronavirus risks causing panic, further distress, and stigmatization of marginalized and affected groups. Globally, self-isolation has also driven a shocking rise in domestic violence. In Yemen, rates of gender-based violence have risen 63 per cent since the conflict began. The pandemic response must work to mitigate the additional risks to Yemeni women and girls.
Compounding these challenges, conflict activity that declined in 2019 is again on the rise threatening to undermine optimism that political developments at the end of 2019 may have been building towards a political resolution to the conflict.
Warring parties have placed increasingly severe bureaucratic impediments on aid delivery and humanitarian access, keeping vital aid and assistance from desperate Yemenis.
At the end of February 2020, 123 NGO projects remain unimplemented because authorities have not approved the relevant paperwork, impacting an estimated 8.2 million people. If the current situation continues many lifesaving humanitarian projects on which Yemenis depend will run out of funding by the end of April.
Urgent steps must be taken to mitigate the impact of the pandemic in Yemen, and to address what was already the world’s largest humanitarian crisis. First, Yemenis need immediate relief from the fighting. The warring party’s agreement to the first nationwide ceasefire since 2016 to support the covid-19 response in a vital first step. Now robust and energetic diplomacy is needed to turn words into action on the ground to reduce the violence and to ensure a return to inclusive, UN-brokered peace talks.
Second, international donors should adopt a holistic and coordinated approach to coronavirus response in Yemen. Trust is imperative in the fight against infectious disease, but that can be lost if broader health and mental health needs are neglected. Urgent funding to support the entirety of Yemen’s health system is vital; this means ensuring health workers are paid, drugs supply maintained, and critically, coronavirus interventions are coordinated with sexual and reproductive health and protection actions to meet the specific needs of women and girls.
Third, we need bold, coordinated diplomacy to secure commitment from warring parties to remove all impediments to the delivery of humanitarian assistance into and around Yemen. With COVID-19, cases likely to rise in the coming weeks it is critical that humanitarian staff are able to work effectively and donors avoid conditions or suspensions that would undermine preparedness efforts and primary health delivery.
Finally, warring parties should make a public commitment to respect international law, particularly focusing on the protection of medical facilities and health workers.
The coronavirus hasn’t created the need for a ceasefire for health system funding, nor for the respect of international law, but it demonstrates just how urgently action is needed, and how high the human cost will be if there is a return to conflict as the virus takes hold.
We have seen the first-hand the effects of this pandemic on wealthy, stable states. To limit the worst outcomes in Yemen, Yemenis and their fragile health system must be supported now.
Marcus Skinner is Senior Conflict and Humanitarian Policy Adviser with the International Rescue Committee.