By Giulio Coppi
Two years into its current crisis, Yemen is torn apart by an interlinked series of conflicts with intricate and mobile front lines. These have resulted in what the UN has called “the largest humanitarian crisis in the world.” While compounded by decades of conflict, violence, and underdevelopment, the major cause of the humanitarian crisis in Yemen remains the conflict between the two competing governments, along with the intervention of the Saudi-led coalition.
This report assesses the humanitarian situation in Yemen, including the impact of the country’s conflicts on its healthcare system, economy, and infrastructure, as well as the resulting population movements. It also examines current humanitarian actors and responses in Yemen and in neighboring countries. It concludes by exploring several challenges and opportunities for humanitarian actors in Yemen. These include:
Enhancing respect for humanitarian norms and principles: A strong and unified initiative aimed at enhancing respect for international humanitarian law could not only protect populations at risk but also ease tensions among different communities within and outside of Yemen. The UN Security Council could help in this area by playing a more proactive role. Humanitarian actors also need to strengthen the perception of their neutrality.
Strengthening the humanitarian response: The many actors involved in the humanitarian response should improve coordination, adopt existing tools for publishing and sharing data, and explore innovative uses of technology. International humanitarian actors should also directly involve local private sector actors in humanitarian action and include local humanitarian actors in coordination and decision making. In addition, humanitarian organizations could push blockade authorities to facilitate access for both humanitarian and commercial shipments.
Looking beyond immediate humanitarian needs: While it remains critical to invest in the humanitarian response, the international community also needs to invest in prevention in order to stem humanitarian needs and prevent further deterioration of the humanitarian crisis. This includes supporting Yemen’s healthcare facilities to prevent their total collapse and addressing the economic and financial impact of the lack of liquidity. A gender-based approach to the humanitarian response is also needed, reflecting women’s roles as potential peacemakers.
Published on Reliefweb on January 30, 2018
As the conflict in Yemen passes the grim 1,000-day milestone, the United Nations is warning that if humanitarian workers cannot gain greater access and the violence does not subside, the cost in lives will be incalculable.
“As violence has escalated in recent days, children and families are yet again being killed in attacks and bombardments,' the heads of key UN agencies said Friday in a joint statement, as they once again appealed to parties to the conflict to immediately allow full humanitarian access in Yemen and to stop the fighting.
World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, World Food Programme (WFP) Executive Director David Beasley, and UN Children's Fund (UNICEF) Executive Director Anthony Lake, painted a dire picture of what 1,000 days of brutal violence in Yemen has wrought saying the fighting has driven families from their homes, destroyed hospitals and damaged schools.
“More than 1,000 days of children recruited to fight […] 1,000 days of disease and death [and] of unimaginable human suffering,” they said, adding that the conflict has created the worst humanitarian crisis in the world – a crisis which has engulfed the entire country.
Some 75 per cent of Yemen's population is in need of humanitarian assistance, including 11.3 million children who cannot survive without it. At least 60 per cent of Yemenis are now food insecure and 16 million people do not have access to safe water and proper sanitation. Less than half of Yemen's health facilities are fully functional and medical staff has gone months without being paid their salaries.
“This horrific tally of the conflict's devastation reflects only what we know. In reality, the situation is likely to be worse. UN agencies do not have full humanitarian access to some of the hardest hit communities. In many, we cannot even assess their needs,” the UN leaders explained.
“But this we do know: Yemen has passed the tipping point into a rapid decline from crisis to deepening catastrophe.”
While acknowledging some progress in recent days with the first commercial fuel imports allowed into Hudaydah port, following recent commercial food imports, the agency chiefs said it is critical that these supplies are maintained, as restrictions on fuel imports have caused the price of diesel fuel to double, threatening access to safe water and sanitation, and urgent medical care.
Far too many hospitals are short of fuel for the generators that allow them to stay open. Water pumping stations serving over three million people are quickly running out of the fuel they need to operate, while the price of commercially trucked water has increased up to six-fold.
“Safe water is now completely unaffordable for more than two thirds of Yemenis living in extreme poverty. All of this threatens to undermine efforts to contain the ongoing, deadly outbreaks of diphtheria, cholera and acute watery diarrhea,” they warned.
“We remain committed to helping the people of Yemen. We have reached nearly six million people with clean water, distributed 3.7 million litres of fuel to public hospitals, treated more than 167,000 children for severe acute malnutrition,” they noted but warned: “Yet worsening conditions on the ground threaten to overwhelm our capacity to respond.”
“Yemen's families should not have to withstand another day of war, let alone another 1,000,” the UN leaders concluded.
Published on the UN News Centre on December 30, 2017.
Oxfam and 17 other humanitarian agencies expressed serious concern today over the Saudi Arabia-led Coalition’s decision to temporarily close all entry points to Yemen, effectively sealing the country off. The agencies demand that humanitarian operations are allowed to resume immediately and request clarity on the planned duration of the current closure and contingencies to allow humanitarian supplies to be delivered.
On Monday, the Coalition ordered the temporary closure of all Yemeni ground, air and sea ports, amongst other measures. Their statement said this was to address vulnerabilities in the inspection process, while maintaining the entry and exit of humanitarian supplies and personnel. The statement did not however, give any clarification on the duration of the closure, or how humanitarian assistance can be delivered.
Given the current acute food-security crisis and cholera epidemic, any delays to the restoration and expansion of humanitarian access will cost the lives of women, men, girls and boys across the whole of Yemen.
Johan Mooij, CARE Country Director, said: "While we welcome the assurances of the Coalition which has vowed the continuation of access for humanitarian assistance and personnel, aid ships in Hodeida haven’t been allowed to off-load, and at least three United Nations Humanitarian Air Assistance flights have been denied approval since 6th November. We are deeply concerned as this has a direct impact on our ability to maintain life-saving assistance. Yemen is one step away from famine, cholera is rife and provision of public services continues to deteriorate.”
In less than a day, this blockade already hiked up fuel prices in some governorates by as much as 60% as people scramble to stock up, and led to disruption of public transportation. The closure of all sea and land ports means urgently-needed lifesaving medical supplies have ceased, potentially affecting hundreds of thousands of people.
This will also substantially reduce the amount of food coming in the country – already, 1,200 tons of UN food and medical supplies have been delayed going from Djibouti to Yemen. Any reduction in imports and increase in food prices will exacerbate the existing massive hunger crisis and widespread child malnutrition.
Tamer Kirolos, Save the Children Country Director, said: “Supplies of food and medical aid coming though Yemen’s ports are keeping millions of children alive. It’s already been tough enough to get help in – we’ve been forced to rely on routes that are long and slow for years. But if access shuts off entirely, even for a single week, then disaster will be the result. This is the nightmare scenario, and children will likely die as a result. It is crucial that aid workers and vital supplies like food, medicine and fuel are permitted to enter Yemen freely and without delay, and all blocks are removed.”
In the absence of clarity and detail from the Coalition, worrying questions remain about the extent and duration of these measures and their expected impact on the civilian population. If this issue is not resolved immediately, we fear an already catastrophic humanitarian and economic crisis will get substantially worse.
Furthermore, the humanitarian sector alone cannot fulfil the needs of the civilian population in Yemen as we cannot replace the commercial sector’s ability to supply essential goods to the Yemeni people.
Shane Stevenson, Oxfam Country Director, said: “Yemen is the world's biggest humanitarian crisis, with 21 million people in desperate need of assistance. To prevent more lives from being lost and the needless suffering of millions, it is vital that aid is not delayed or impeded another hour. The Coalition needs to clarify immediately the measures it has taken and ensure that aid deliveries to Yemen and humanitarian operations are not affected in any way.”
Published on OXFAM on November 8, 2017.
By Samantha Schmidt and Daniel Cassady
The intensive care unit was sweltering in the afternoon heat, the doctors covered in sweat and fanning themselves with their scrubs. Already compromised by weakened physical conditions and a lack of food and water, intubated patients melted under individual fans.
“It’s an oven,” said Cesar Castillo, a surgery resident at Centro Médico Hospital in San Juan. “It’s hard to get their fevers down.”
It has been more than a week since Hurricane Maria devastated Puerto Rico, and the humanitarian crisis that has ensued is nowhere more obvious than in the health-care facilities that often are without electricity and always are overwhelmed.
About half of the island’s hospitals — 33 — are functioning. Those that are accepting patients have intermittent power and have to pray that the diesel fuel running their generators will last until the next truck arrives.
Forced to take people from hospitals that have closed, hospitals outside San Juan are over capacity and overwhelmed by patients. Some hospitals have become more akin to community centers, with people lining up to use the cafeterias, and relatives of patients trying to use the showers and bathrooms because they don’t have water at home.
Doctors across Puerto Rico say that many patients, particularly elderly ones, are arriving at hospitals in deteriorating condition because they waited too long to seek treatment, in many cases because they couldn’t find the gas to drive. Others worry that since so many people are without water and electricity, infections and diseases will spread more easily.
Numerous patients already have been treated for dengue — a mosquito-borne virus — in Hospital del Maestro, a small facility in the Hato Rey neighborhood of San Juan. Many people have arrived with herpes, asthma and respiratory problems.
“I lost count of how many people have come with conjunctivitis,” said Lisa Matos, supervisor of the hospital’s emergency room. Conjunctivitis, or pinkeye, is often caused by lack of hygiene, Matos said. Without running water in their homes, people are washing their hands less.
The lack of power, water and fuel is affecting hospitals as it is affecting much of society here.
The San Jorge Children’s Hospital in Santurce was without power for nearly eight hours earlier this week after running out of diesel for its generators; half of the 90 patients there were either transferred or released.
Domingo Cruz, a San Jorge administrator, said his hospital desperately needs a steady supply of fuel. Some staff members are staying at the hospital so as not to waste gas commuting.
“Nothing can function without power,” Cruz said. “Outside right now, we have a tank that holds 4,000 gallons of diesel. The hospital’s two combined building use 1,500 gallons every day.”
Cruz said the situation is going to get worse before it improves.
“During November and December, it’s going to get bad,” Cruz said. “There are going to be cases of dehydration, there are going to be cases of dengue fever. There are going to be people with diabetes who haven’t been taking care of themselves because their focus has been on rebuilding their lives and taking care of their families.”
Centro Médico gained electricity for about two days, but lost it again, forcing the hospital to rely solely on generators. Just four of the hospital’s more than 20 operating rooms have been open on a daily basis, because the others lack water or fuel, said Segundo Rodríguez Quilichini, chancellor of the University of Puerto Rico’s Medical Sciences Campus.
Scores of patients have been forced to delay surgeries, and doctors are “desperate to do their jobs,” said Juan Nazario Fernandez, a senior medical officer.
The San Juan hospital is a base of operations for Health and Human Services, a command center for critical and acute care. Seven regional hospitals have been deemed primary medical care hubs for the island’s more than 3 million residents.
Hospital HIMA San Pablo Caguas, about 22 miles south of San Juan, is a hub for the eastern region. A sign on the main entrance doors Wednesday indicated that just one visitor per patient would be allowed in, for security reasons. The hospital is well over its maximum capacity of 405 beds.
“Every single square foot here is being dedicated for clinical purposes. The logistics are crazy right now,” said Armando Rodríguez, the hospital’s vice president. In the emergency room, hospital beds clogged hallways. “This is not the way to run an ER.”
Gloria Dominguez, 81, had been in the emergency room since 8 p.m. the previous night, having called an ambulance because of chest pains. By 2 p.m. the next day, she had not yet been placed in a bed. Instead she had been sitting in a chair, receiving oxygen, all night and all day.
Feet away, lying in a bed surrounded by other patients, Pablo Rosario received antibiotics through an IV. After a foot of water had entered his home in Juncos, Rosario developed an ulcer on his left foot. On Sunday, he tried going to a hospital in Humacao, but the roof of the operating room had blown off. So he was transported to Caguas.
He needs surgery, but “they don’t know when” he can have it, said his wife, Liduvina Martinez Rodriguez. There are not enough beds to admit him to a room.
The hospital also was still treating 28 patients from the islands of Tortola and St. Thomas, people who had been airlifted out after being rescued in the aftermath of Hurricane Irma earlier in September.
“They opened their eyes and didn’t know they were in Puerto Rico,” said Natalia Rodríguez, a hospital staff member. Many have had no contact with family, and the hospital has been unable to communicate with its partner hospital in Tortola since Irma.
The hospital’s vice president is most concerned about the patients receiving dialysis — several times as many as the hospital usually takes in. About 140 patients were on dialysis in the Caguas hospital on Wednesday, while it usually receives about 15.
“I don’t have the space for more people,” he said. “I am very worried, not for the ones that are here. I’m worried about the ones that are not.”
But the HIMA hospital was lucky to have plenty of diesel and water reserves, Rodríguez said. It also received a large shipment of supplies that day from the National Guard. Other hospitals aren’t so lucky.
Just before noon Wednesday, Ruben Norat Roig, administrator of Centro Médico Menonita in Cayey, was running out of diesel to run generators for his dialysis patients.
“I have enough until 3 p.m.,” he said. “I don’t have anywhere to put them.”
While a diesel truck had arrived to fuel up the generators for the main hospital, the hoses did not match up with the generators for the dialysis center. But at least the diesel distributed Wednesday would give the hospital enough fuel for three days.
“That was like winning the lottery,” he said.
Rep. Richard E. Neal (Mass.), the ranking Democrat on the House Ways and Means Committee, said Thursday that dialysis patients who can’t get proper treatment are “in dire condition due to Puerto Rico’s lack of needed fuel and supplies” and in a statement urged evacuation of patients if supplies can’t be made available soon.
“I am deeply concerned about reports from Puerto Rico that millions of people, including thousands of dialysis patients, are not receiving the urgent medical care they depend on,” Neal said. “In this day and age, no American should ever die of a manageable medical condition.”
In places outside San Juan, such as the hospital in Cayey, a near-total lack of communication has created a nightmare for doctors. The hospital’s electronic records system is down, forcing doctors to note information manually and leading visit times to double. With no phone reception, doctors can’t be on-call from their homes, so they’ve been forced to sleep in the hospital, using rooms that could house patients.
Other hospitals have struggled to contact cadaver centers, or families of the deceased, leading morgues to fill up. Marta Rivera, the head of an association of Puerto Rico hospitals and executive director of Hospital San Juan Capestrano, said she could not determine exactly what supplies hospitals across the island need because she can’t contact many of the administrators.
In the Hospital de Maestro’s dark emergency room Thursday, Janet Colon Ramos lay in a hospital bed, receiving treatment for shingles. Colon Ramos — who lives in the town of Corozal, more than 20 miles southwest of San Juan — waited four days to get treatment for the virus. With no Internet service or phone reception, she didn’t know whether hospitals were open, and she didn’t want to risk running out of gas searching.
Colon Ramos had been told the shingles might have been activated by stress.
“Having to give breakfast, lunch and dinner to three kids with no water or power?” she said. “It’s stressful.”
Published on The Washington Post on September 27, 2017.