Nahla Arishi, a pediatrician, washes her hands after attending to people infected with diphtheria at the al-Sadaqa teaching hospital in the sourthern port city of Aden, Yemen, December 18, 2017. REUTERS/Fawaz Salman
ADEN, Yemen - 1 May 2018: We continue our investigation by monitoring the crimes of the Houthis in the health sector, an investigation which has taken us across the country and revealed how a lack of ambulances, medication and funding for doctors has led to an urgent crises in the health sector.
After completing the necessary security procedures, we initially visited the General Hospital of the Republic and the Basheib Military Hospital in Aden. The first thing to catch the eye was the large number of people in the hospitals, all with a plethora of health complaints. Hospitals are desperately trying to meet the needs of patients, however are struggling with limited personnel and insufficient equipment. While hospitals have attempted to rebuild after substantial attacks by Houthi rebels, the shortage of medical supplies, medicines and equipment is hindering doctors at work. However, they insist on survival between the hammer of Houthis’ looting and the aid organizations that do not meet the needs of the people.
Queen Elizabeth in Aden Colony, 1954, wielding a spadroon in preparation to knight Claude Pelly and Sayyid Abubakr. Prince Phillip is visible at the side. This was the first public investiture of the tour, April 27, 1954 - Wikimedia/Unknown
Republican Hospital ques, disruptive devices and oxygen deficiencies
Queen Elizabeth II did not know that the hospital for which she laid the foundation stone 64 years ago, would become a theater of Houthi rebel military operations. The Queen laid the stone at the Republican General Hospital on April 27, 1954, during a visit to Aden on her honeymoon, hoping that it would be a distinctive landmark in the province.
The Republic is one of the most important hospitals in Yemen, but has been looted and bombarded by Houthi rebels in 2015. After its liberation, officials tried to restore its full capacity, but there are still obstacles that need to be overcome. Among the line of patients waiting to be seen, we met 60-year-old Uncle Abdallah, carrying an envelope filled with many papers.
"I went to many hospitals,” he said, “I suffer from kidney failure. There is no possibility to start dialysis treatment here, and treatment that is available at private hospitals is beyond our means. My daughter also has heart problems and suffers from attacks, but there is no medication, and even if it was available, is is very difficult to acquire for poor people like us.”
“Medicine is not available”: Zaynab, a mother of three children who suffers from cancer and needs chemotherapy, told us. When she saw us, she rushed to talk to us in the hope that we’d be able to assist her.
“I don't sleep at night because of the pain, and the treatment does not exist [in Yemen]. I come to the hospital and they help as much as they can, but chemotherapy is not available, and I have three children whose father died from a Houthi rebel shell. I don't work but we get subsidies from charitable organizations occasionally, and other times we are able to receive a basket of food once a week, enough for is one meal. We go hungry for days at a time.”
“I am from Lahj and I came to Aden to receive treatment. Sometimes me and my 8-year-old daughter come but don't find treatment, so we leave and return again,” Fatima Mohammed, a patient at the Republic Hospital, told us. “Treatment is available in private hospitals but is expensive and we can't afford it.”
We left Zaynab and the queues of patients as Dr. Nasser Al-Mardi, head of the operations department, took us around the hospital to see the operating rooms. Patients were being operated on dilapidated beds, and only in small numbers. Doctors have only simple surgical instruments with which they try to save patients' lives.
Mardi explained that there’s an urgent need for surgical necessities, including anesthesia, surgical thread, and operation tools. He added that 20 to 30 surgeries are performed daily, including many serious cases which come from the front of the security belt on the western coast, where fighters face snipers, mortars and shelling, among other threats.
"We have a severe shortage of artificial respiration, oxygen and anesthesia, and the capacity of beds is not enough. There are cases that we cannot receive patients, because there is no medication,” he said.
Dr. Ahmed Salem al-Jarba, the director of the hospital, explained to us that this is the main hospital in Aden and serves five neighboring governorates, adding that they receive between 20 and 30 wounded individuals daily, with various injuries.
Al-Jarba pointed out that the Houthis transformed the health sector buildings and hospitals into military barracks, and erected military hardware. They targeted health centers, medical staff, ambulances and paramedics. Some 153 health facilities were destroyed, and diseases spread rapidly in areas under their control. Epidemics such as cholera and malaria spread as a result of the damage done to facilities and infrastructure, the lack of of clean water and sanitation, and operations ceasing in the Republican Hospital from April to August 2015.
"We are forced to work 24 hours a day, and sometimes 60 people arrive at the same time. In such a case we stop receiving non-emergency cases. We only have 460 beds," he said, adding that there are contributions from international institutions and support from the King Salman Center for Relief and Red Crescent. He further noted their desperate need for modern equipment.
Regarding medication, Jarba explained that it is partly provided by both the government and relief organisations. However, there are basic needs that are not met by relief organizations such as anesthesia and epidemiology drugs, pointing out that the Yemeni Central Relief Committee distributes a proportion to each hospital, without paying attention to differences in needs. "We attach a lot hope to the King Salman Center, which provides much support to the health sector, as well as the UAE Red Crescent,” he explained.
On his assessment of the work of international organizations in Yemen, Jarba said: "We regret that they are not honest in conveying the reality. There are a lot of exaggerations. For example, they are getting loans and a lot of support for cholera and they are telling the world that Yemen is infected, although the number of cases has not been so great. The total number of cases treated here in the center of Aden is only 4,460, a very small number compared to what these organizations declare. The rest were cases of watery diarrhea only, and this center was closed because it is no longer needed, and yet these organizations still promote to the world until today that the Yemeni people are suffering from cholera epidemic.”
Nahla Arishi, a pediatrician, checks a woman infected with diphtheria at the al-Sadaqa teaching hospital in the southern port city of Aden, Yemen December 18, 2017. REUTERS/Fawaz Salman
He pointed out that these organizations include the World Health Organization (WHO) and UNICEF. “They are not only falsifying statistics, but they are creating diseases that are not on the ground for multi-million dollar support.”
He revealed that funding from these organizations is used for spray-cars that repel mosquitos from one place to another for example, without working towards a real solution. Funds allocated for the treatment of diseases, projects fighting malaria for example, is wasted, and 35 percent of these organizations’ budget goes towards administrative expenses.
Basheib military hospital in Tawahy is the one receiving the largest number of patients. The director of the hospital, Salem Hassan al-Attas, told us all about their suffering during the Houthi rebel siege of the area. He pointed out that the rebels used the hospital as military barracks, and prevented all supplies entering while the number of wounded rose dramatically.
"We relied on the aid of the popular resistance by sea, and out of fear for the lives of the wounded, we smuggled the aid by boat to the region of Brega. This is because if the Houthis caught an injured person they would kill them without mercy. Some could not endure the hardship of the trip, and died during attempts to smuggle them. The militias grabbed young wounded people who were transferred by car to the hospital, killed some and took others as prisoners. They also attacked the hospital several times, destroyed vital equipment, and were looking for the wounded. Then the hospital was closed until the liberation.”
Dr. Salem said: "We continue to receive wounded people from the fronts. Since the liberation of Aden we have been working on restructuring the hospital. We have built some buildings, and parts are still under repair. We have provided as much equipment as possible There will be 360 beds, but there are still missing needs such as a heart center and a radiology center, because the Houthis destroyed the radiology devices. The cost of a device now is $350,000, there are other medicines we need in addition to ambulances; we rely more on the support of the state than relief organizations. There is also little money to pay staff, and often doctors have to work for free.”
International organizations deny claims
In response to accusations from hospitals, the head of health operations at the WHO office in Aden, Dr. Omar Zain, denied the allegation that diseases are promoted which do not exist, in order to extract money from donors. He stressed that the WHO is an international organization and not a personal one, arguing that without the intervention of the organization, cholera would have worsened in Yemen. He pointed out that there is a mechanism to control the distribution of donor funds, through an independent observer between the organization and the donor.
Regarding the continuation of agreements on cholera, despite the decline in the incidence of infection, he said: “First it is the grantor who determines the health program, in which the disbursement of the amount is either for primary services, hospital support or structural support of the health system. Secondly, we directed large support to address the epidemic when it was widespread through the opening of centers for treatment and hospital support. We cannot stop completely allocating a budget for the epidemic, because there is still a possibility it will return since the causes of the disease are present; we are coming on to a rainy season which helps in the transmission and spread of the epidemic. Furthermore, more than 50 percent of the population does not get clean water, and there are sewage problems on top of the accumulation of the displaced.”
On the programs dedicated to malaria and dengue fever, Dr. Zein said: “It is not true that it is directed to awareness and training only, but there are laboratory tests for the infected to monitor the infection rates. There is a therapeutic part of the infected, both endemic diseases appear according to seasons. Their proportion varies from one place to another inside Yemen according to the vector mosquito, and in any case we need a proactive plan for any new pandemic.”
"We do not deny that there is a shortage of equipment and tools, but hospitals need a lot of things. There is no one in the world who can cover all hospitals even in developed countries, and donors cannot," he said.
UNICEF, through its office in Aden, confirmed that it was providing support through health, education, water, sanitation, hygiene and protection programs, explaining that in 2017, in cooperation with the Ministries of Education and Health, it had trained 6,000 teachers to implement the cholera outbreak response in schools, which target 2.4 million students, and provided 6.8 million people with water and sanitation services by supporting the water municipality and transporting them on trucks.
UNICEF’s office added that the organization contributed to the second national polio campaign and continued to receive routine vaccinations through 2,940 health centers in Yemen. More than 404,400 children benefited from psychological support services and the organization supported 1.4 million children in Yemen through the rehabilitation of schools.
The Yemenis suffer because of the ongoing conflict of severe shortages of humanitarian, basic and service items in the areas of sanitation, water, education and health. More than half of Yemen's population do not have access to safe water, 11 percent of schools are destroyed or out of service. Some 25 percent of students are out of school. There are more than one million people suffering from cholera, in addition to outbreaks of diphtheria, acute watery diarrhea and more than 1.8 million severely malnourished children. There are programs to meet these humanitarian needs.
The organization has a permanent presence in five offices throughout Yemen, conducting regular visits to its project sites. It also has a network of local partners and regular monitoring mechanisms to deliver humanitarian assistance on a daily basis, including the use of independent third-party monitoring throughout the country.
In 2017, the annual needs were estimated at $339 million, 61 percent of the requested support was received, and in 2018 UNICEF needs an estimated $350 million, and 5 percent of the support required has been received so far.
As for the complaints of the people that the organizations are dealing with on the Houthi side, which is not reliable to deliver aid to the beneficiaries. The evidence of which is the death of children out of starvation, as in Hadida. the organization responded that it works in Yemen to secure the needs of children and the delivery of services to them wherever they are and, in all regions, and regardless of the dominant conflict.
In the next episode, more on hospitals and patients suffering.