Aid groups act to stop Yemen's next major cholera epidemic

Al-Monitor visits a cholera treatment center in Yemen, where a three-year war has intensified the spread of the contagious illness.

al-monitor Workers spray pesticides during an anti-cholera campaign in Sanaa, Yemen, March 21, 2019.  Photo by REUTERS/Mohamed al-Sayaghi.

Apr 25, 2019

AMRAN, Yemen — After a fortnight of suffering from acute diarrhea, Dhaifullah al-Yemeni finally vomited, and was subsequently transferred to the Cholera Treatment Center in the Khamir district of Amran, in central Yemen.

He was close to death, just like those who died before him on their way to the hospital due to lack of awareness of the disease's symptoms, and those who pass away at home because they cannot afford transportation.

“I threw up a lot yesterday,” Yemeni recalled, while receiving treatment at the Cholera Treatment Center affiliated with Doctors Without Borders (known by its French initials, MSF) in Khamir on April 12. “It's been 15 days of suffering from acute watery diarrhea, but no vomiting. Yesterday [April 11] I decided to come here.”

Yemeni, 65, is an internally displaced person from Maran, in the northwestern Saada province, the birthplace and stronghold of Abdul Malek al-Houthi, the leader of the Houthi group.

Yemeni has five children, including a boy he claims was killed in his village, during the fifth war between Ali Abdullah Saleh's government and the Houthis in 2008. He declined to give further details on the circumstances of his death.

Yemeni, who has been living in Khamir in a rental house for 11 years, was confirmed cholera-positive by a medic who spoke to Al-Monitor on condition of anonymity because he is not authorized to speak to media.

Yemeni, on his second day at the center, is among 3 million Yemenis who have fled their homes, according to estimates from the UN Office for the Coordination of Humanitarian Affairs. 

Dhaifullah al-Yemeni (Naseh Shaker/Al-Monitor)

The medic said Yemeni is like many civilians who have no awareness of cholera and thus die before reaching a hospital or on the way to it. “Poverty and inability to afford transportation makes it hard to be transferred to a hospital,” Yemeni said.

In August 2018, Peter Salama, World Health Organization deputy director-general of emergency preparedness and response, told a UN briefing in Geneva that Yemen “may be on the cusp of the third major wave of cholera epidemics.” Yemen has already witnessed two major waves of cholera epidemics.

According to Yemen's Ministry of Health, from January 2018 to April 2019, cholera is the suspected cause of at least 470 deaths. The "outbreak has affected 21 of 23 governorates and 286 of 333 districts in Yemen since the beginning of 2019," according to the WHO.

It is said the waterborne disease is endemic in Yemen, where the worst outbreak of the disease in history was in 2017, when more than 1 million cases were reported and 2,500 people died of the infection between April and December of that year.

MSF said in a March 27 statement that its teams have opened a 50-bed cholera treatment center in Khamir.

At the end of Yemeni's treatment bed sits Ameen, his 15-year-old son.

Ameen, who left school to be by his father’s side, declined to speak about his feelings on his father's condition. “What's the importance of speaking while [my father] is still ill?” Ameen told Al-Monitor.

It is hard to persuade Ameen to be optimistic. “How can I be optimistic while my father is ill?”

‘I wish this war was over’

Yemeni is one of the few people still retaining a Saadi nomadic lifestyle after being displaced by the war. Yemeni still drinks coffee in the Saadi tradition, with special cups and a thermos for the world-renowned Yemeni coffee. He puts the thermos full of coffee — without sugar, because he suffers from diabetes — on a small table near his hospital bed.

Under the table, there is a plastic bag full of drugs for his noncommunicable diseases such as cardiovascular disease and diabetes. The medic confirmed to Al-Monitor he suffers from these diseases.

“I wish this war was over, so everyone could go back home,” Yemeni said, recalling when he used to live in his village of Maran before the war.

Cholera attack hits high in Huth

On March 27, Hassan Boucenine, MSF's head of Yemen mission, said his organization is supporting a hospital treating cholera cases in Huth, around 100 kilometers north of Sanaa, adding, “The attack rate is particularly high in Huth, in Amran governorate, where we support a health center.”

Huth hospital, Amran governorate, Yemen (Naseh Shaker/Al-Monitor)

On April 13, I arrived at Huth hospital and directly reached the facilities supported by MSF, but the cholera center is supported by UNICEF, according to a staff member.

Inside the hospital's Cholera Treatment Center, there were three cholera-positive individuals, each lying in one of the center's three rooms. All cases were admitted days ago. “Only six suspected cholera cases have been admitted Saturday [April 13] for the past three morning hours,” head of the center Yahya Omran told Al-Monitor.

In one of the three rooms, four women were escorting a woman, Tayseer. Her mother-in-law told Al-Monitor she has cholera and came from the nearby district of Bani Ghuthaima.

In the second room, a grandmother sits near her 3-year-old grandchild, Batoul Darawan. Darawan has been hospitalized for three days, after a local health facility in Khaiwan village in the Huth district transferred the patient to the hospital.

Batoul Darawan and her grandmother (Naseh Shaker/Al-Monitor)

“The boy's mother can't be beside her son, because she is breastfeeding for her newborn baby,” Darawan's grandmother told Al-Monitor.

Huth’s main hospital has not only treated cholera, but also those wounded in the war, especially in 2014, during fighting between Houthi fighters and the sons of former parliamentary speaker Abdullah al-Ahmar.

At the Huth cholera center, the last death occurred April 3. Hassas Naser Ahmed was from al-Ashah district, and was transferred to Huth hospital owing to bad health services in al-Ashah, according to Omran.

There were four deaths at Khamir hospital in March, and one death at Huth hospital in February, according to Yahya al-Shuraimi, a medic at Huth hospital. Al-Monitor couldn't reach their homes to interview relatives and see their living conditions because of the difficult terrain and a gas shortage that made it hard to reach their rural houses.

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