Inside Yemen's Tragedy—Part Three
FIRST-HAND REPORTING FROM THE WORLD’S WORST HUMANITARIAN CRISIS
Written by Nebras Khaled, Health Program Manager, Sana’a
Editor’s Note: International Medical Corps’ Yemen Blog presents a rare view of life on the ground in Yemen, chronicled by our first responders as they battle one of the world’s worst humanitarian disasters—fueled by poverty, hunger, disease and a civil war now in its sixth year, with no end in sight. Yemen’s misery has only gotten worse since COVID-19 began to spread earlier in the year.
The entry below is written by Dr Nebras Khaled, our Health Program Manager. She is based in Yemen’s capital, Sana’a, where she grew up, earned her medical degree and lived much of her life before joining International Medical Corps in 2014 as a mobile medical team leader. Her current responsibilities include helping to implement our healthcare, nutrition and water, sanitation and hygiene (WASH) programs in three districts of Sana’a Governorate that have been hit especially hard in recent years by the effects of war, crippling food shortages and high rates of cholera.
Since the war in Yemen began in 2015 and the economy collapsed, many families who in earlier years had migrated off the land to urban areas in search of better jobs and more comfortable lives have had no choice but to return to their villages. As a senior community health officer working in villages within a few hours drive from the country’s largest city and capital, Sana’a, I have witnessed personally the crushing disappointment of these families as they return to uncertain futures on the edge of hunger and despair.
Among those hardest-hit have been families of government employees, solely dependent on their salaries to afford the benefits of urban living such as decent housing and other essential transportation. As war crushed economic activity, damaged infrastructure and snuffed out new business opportunities, government income fell and payments to state employees stopped.
Since starting with International Medical Corp two and one-half years ago, I watched many of these families return home, unable to survive in cities with little or no incomes. This reverse migration has strained the already meagre resources of poor rural communities. In this environment, we’ve done our best to provide returnees—and all village residents—good quality medical and nutrition services. We also raise awareness about the importance of good health in villages that are hours by car from the nearest medical facility.
I still recall my first visit to such a community. It was in September 2018, to the village of Dayan, about two hours by car from Sana’a. By any measure, the public health conditions we faced were alarming. Malaria was rampant, fueled by the many swamps surrounding the village that provided ideal mosquito breeding grounds. In one house, every resident showed signs of the disease, including three children under 5, all of them suffering convulsions.
As a senior community health officer I realised that, if we were going to save lives, we had to move fast, not just in Dayan, but in other villages in the area in similar straits. But with the nearest medical assistance hours away, we realised there was only one option: work with village leaders to establish Dayan’s own healthcare system to treat and manage the outbreak. I’m proud to say we succeeded.
In the two-and-one-half years since that first visit, working with villagers and Government Health Office officials from Sana’a, our team has recruited 48 community health volunteers. We then provided them with the basic medical knowledge, equipment and supplies needed to implement such a system -–one known in Global Health circles as integrated Community Case Management (iCCM) that. In addition to malaria, we have used to treat two other diseases considered potential killers for young children: anaemia and diarrhoea.
In addition to a well-trained, home-grown healthcare staff, we have provided an around-the-clock ambulance service to enable swift hospital transfer of urgent cases requiring special attention. Today, we help supervise this work. We also organise community awareness campaigns about the importance of strong healthcare and provide village residents the opportunity to give feedback on the care they receive via a telephone hotline.
The results have been impressive. The system we’ve established has treated more than 13,000 children and transported more than 500 individuals—mainly small children and pregnant women—to distant medical facilities, all while the villages we support have seen a marked reduction in the number of cases of malaria. Because of this experience, also now participate in the development of the national strategy for malaria control. None of this has been easy—especially as the war continues and economic conditions remain bleak. We know it’s going to take time before peace and real change comes to Yemen, but with many small steps, we’re making progress.