The world’s worst outbreak of cholera is gripping Yemen during nearly three years of a civil war pitting Iran-backed Shiite Muslim rebels against a struggling central government propped up by the United States, Saudi Arabia and other Sunni Arab powers in the Persian Gulf.
More than 2,000 people in Yemen have died as a result of the waterborne disease since April, and the tiny nation passed the distressing milestone last week of more than 500,000 suspected cholera cases. The United Nations said the situation is likely to get worse before it improves.
“It grieves me that in these last two years, and despite my and my team’s best efforts, I have been unable to report any significant improvement,” said Stephen O’Brien, U.N. undersecretary-general for humanitarian affairs.
He described the cholera outbreak during testimony before the U.N. Security Council as a “deplorable, avoidable completely man-made catastrophe.”
Despite Mr. O’Brien’s assessment, the crisis remains largely overlooked by wealthier powers of the region and the world’s media, which more often than not focus on the geopolitics of the Saudi-Iran proxy war playing out in Yemen rather than the humanitarian hell that has come increasingly to underpin one of the darkest periods in the turbulent history of the Middle East’s poorest nation.
A majority of Yemen’s 26 million people are struggling to survive. Less than half of the population has access to clean water, 17 million lack reliable access to nutritious food and some 7 million are facing the outright threat of famine, according to international aid figures.
A breakdown in infrastructure and massive electricity losses have led to a lack of proper sanitation, which has contributed to the cholera outbreak. The problem is exacerbated by the closure or destruction of the vast majority of health care facilities and hospitals in Yemen.
While Washington rhetorically supports the Saudi side of the war, international aid groups accuse Saudi Arabia of fomenting the crisis. UNICEF has said dozens of hospitals have been destroyed since an escalation in violence last spring, and Doctors Without Borders claims the Saudi-led military coalition, which is backed by assets from Britain, have bombed hospitals as part of the campaign to keep Iran-backed rebels from taking over Yemen.
Nongovernmental organizations and humanitarian workers scrambling to stem the cholera outbreak are trying to preserve what little infrastructure remains in place. Despite the magnitude of the crisis, many express optimism that progress can be made — and can be driven by the Yemeni population — even as the United Nations struggles to get several of the world’s wealthier nations to follow through on promises to fund a major emergency aid package.
“Yemenis are very resilient people, and they are known for their resilience,” said Dr. Sherin Varkey, UNICEF’s deputy representative in Sanaa. “I think that is what is kind of holding the country at the edge.
“But I still feel that very soon we’ll reach a tipping point,” Dr. Varkey told The Washington Times in a telephone interview recently. “If the situation continues to spiral downwards as it currently is, there will be a time when the resilience will no longer hold.”
U.N. member nations and aid organizations have raised roughly 40 percent of a proposed $2.3 billion budget for humanitarian assistance in Yemen. U.S. government aid organizations have provided nearly $500 million, according to USAID figures.
Afraid to eat or drink
An outbreak of fighting in Yemen in 2015 resulted in Iran-backed Houthi rebels taking control of the nation’s north, as well as much of Sanaa, the capital. The nation’s south is now controlled by the internationally recognized government of Abded Rabbo Mansour Hadi — supported by neighboring Saudi Arabia, other Gulf states and Washington.
One young man who fled Yemen in 2015 and made it to the United States worries constantly about the fate of his family back in Sanaa.
The young man, who gave his name only as Mohammed out of fear of talking to a U.S. reporter, said his family, living in a secluded upscale neighborhood of the capital, is better off than most others.
But the family of 10 is in the heart of territory controlled by Houthi rebels. They rarely leave their house — partially out of security fears but also because of seething paranoia about cholera.
Mohammed told The Times in an interview that his family members protect themselves from the disease by buying fruits and vegetables from a trusted source on the black market. The vendor swears the food is washed only with clean water, and no one in the family has become sick.
Without work for a year, the family relies on money Mohammed sends from the U.S. On that one day each month when Mohammed sends money, he prays his family is able to retrieve it unharmed. Most often, he said, the family will ask his mother to hold the money any time they have to go outside the home.
“The reason,” he said, is that ” if you are a woman, you might be more protected from the Houthis.”
“They will not come speak with a woman; they will respect a little bit that she’s a woman,” Mohammed said.
Dr. Varkey, the UNICEF deputy representative in Sanaa, told The Times that he and other aid workers have been able to work between Yemen’s northern and southern areas relatively unhampered.
But as the cholera outbreak worsens, Dr. Varkey said, his staff members are consumed with providing lifesaving hydration, setting up ad hoc medical facilities and training volunteers to educate the public about proper sanitation.
Cholera causes acute watery diarrhea, spread by the bacteria Vibrio cholerae found in water contaminated by feces and refuse. It is an acute danger in Yemen, where aid workers say roughly 30 percent of the population still practices open defecation.
Compounding the situation, some 30,000 local health professionals have spent the past year working without salaries. Aid organizations find ways to provide food for the workers and try when they can to provide stipends. But some local health professionals have found other ways to get paid, said Dr. Varkey, who noted instances of “informal payments and user fees being charged.”
“It’s very difficult to sometimes comprehend the situation,” he said. “These people have to look after their own families as well.”
Dr. Varkey stressed the need for aid organizations to help with electricity and fuel shortages that have resulted in the closure of water pumping stations and water treatment plants. He said UNICEF is helping provide fuel and power for water systems reaching about 6 million people in Yemen.
The doctor tried to put an optimistic touch on the situation, asserting that, if approached correctly, Yemen could become a model for international aid responses. The focus, he said, needs to be on supporting established infrastructure, including sewage and wastewater plants, in addition to providing immediate, life-saving assistance.
“In countries [where the] public health system has collapsed, it takes much more resources to rebuild it,” he said. “So it is better to focus on preservation now. While we continue to provide immediate lifesaving aid, it is important to focus on these systems.”