Yemen: Crisis update - January 2017

After 22 months of conflict, Yemen is a full-blown humanitarian emergency. After a short ebb in fighting due to the peace negotiations, airstrikes and ground fighting fully resumed, with huge consequences for civilians. All armed actors involved in the conflict, including the Saudi-led coalition and the Houthis, are carrying out indiscriminate attacks without any respect for civilians or civilian infrastructures such as hospitals, schools or markets. Airstrikes are resulting in a disproportionately high level of civilian casualties, with as a sad example the airstrike in Haydan on 13 August which killed 10 people and seriously injured 28 children. On  8 October, an airstrike hit a funeral home killing at least 140 people and injuring more than 500. The main hospitals in Sana’a that received the wounded were supported by MSF with supplies to cover the needs.

MSF health facilities alone have been hit four times. The last bombing, an airstrike on Abs hospital on 15 August 2016, resulted in 19 deaths and 24 wounded, including an MSF staff member. The UN reports that over 600 health facilities in the country have stopped functioning due to damage or lack of staff/supplies and this is affecting access to healthcare for millions of people. Taiz city is one of the worst affected areas of Yemen, with intense fighting including daily shelling in the densely populated inner city. There has been no ceasefire here since July 2015.

MSF health facilities hit by airstrikes/missiles

  • 15 August  2016 - Abs hospital
  • 10 January 2016 - Shiara hospital
  • 02 December 2015 - Tent clinic in Al-Houban, Taiz
  • 26 October  2015 - Haydan hospital

Abs hospital,  Hajjah – 15 August 2016 – 3.45pm

  • Hospital: Abs Rural hospital
  • Location: Abs district, Hajjah governorate, northwestern Yemen
  • Details: An aerial bomb hit the area where the emergency room is located and it was destroyed. It also caused other structural damage
  • Death toll: 19 people, including one MSF staff member: Abdul Kareem al Hakeemi
  • Injured: 24
  • Status: On 18 August MSF evacuated staff. On 27 August the Ministry of Health resumed maternity and emergency services.

On 24 November, MSF resumed full-scale activities in Abs, after major rehabilitation work. Mobile clinics will resume in January 2017.

Abs hospital was the main medical facility functioning in the western part of Hajjah governorate, and had a catchment area of more than 150,000 people.

From January to November 2016, over 9,190 patients were treated in the emergency room, of which more than 50 per cent were medical cases. A total of 166 were war-wounded. More than 850 surgical interventions were performed, of which 194 caesarean sections; 1,197 patients were hospitalised; and 1,670 women delivered in the maternity. Until the withdrawal of MSF in August 2016 the teams were also running mobile clinics, and had undertaken nearly 12,000 consultations.

Shiara hospital, Razeh – 10 January 2016 – 9.20am

  • Hospital: Shiara hospital
  • Location: Razeh district, Saada governorate
  • Details: The missile/rocket hit a corridor leading from the main gate to the hospital buildings, with a metal fence alongside. The wounded were hit by shrapnel from the rocket, and also by shards of metal from the fence.
  • Death toll: 6 people killed, including 3 staff members
  • Injured: 7 people were seriously injured, including 2 staff members. Many others received shrapnel injuries.
  • Status:  For five months after the attack, the hospital was not fully functional and so people did not have access to hospital care. It's noteworthy that the hospital was not even fully functional in January 2016, as it had been hit by a missile-rocket in September 2015 that destroyed the inpatient and the surgical departments.

Shiara hospital is the main medical facility in this town in the mountains, where most of the 40,000 residents live in caves to shelter from the bombs. The hospital serves around 120,000 people in the area. MSF is now supporting the hospital with advanced care (emergency room and maternity) and with donations of medications and financial incentives for the Ministry of Public Health and Population staff.

Almost 9,000 patients were treated in the Emergency Room in 2016, and over 300 patients were referred to hospitals in Saada.

Haydan hospital, Saada – 26 October 2015 – 10.30pm

  • Hospital: Haydan hospital (MSF-supported)
  • Location: Haydan district, Saada province
  • Details: Airstrikes occurred over a two-hour period completely destroying the emergency and consultation rooms, the maternity unit and the inpatient department
  • Death toll: None. Hospital staff and two patients managed to escape.
  • Injured:  One staff member was slightly injured while escaping
  • Status: MSF evacuated its national and international staff in late November 2016 as a result of the airstrike on Abs hospital

MSF will resume its presence with international staff in February 2017. The support to the hospital never stopped even with the evacuation of the team. Haydan hospital was the only functioning hospital in the Haydan area which has a catchment of at least 200,000 people. It had inpatient and outpatient departments, a maternity ward, a laboratory and an emergency room. MSF began supporting the hospital in May 2015. On average MSF was seeing 200 war-wounded patients per month in the emergency room.

Clinic in Al-Houban, Taiz – 2 December 2015 – 11.10am

  • Health facility:  MSF clinic in a hospital tent in an area with a high number of displaced people 
  • Location: Taiz city, Al Houban neighborhood, Taiz province
  • Details: An airstrike occurred 22 metres from an MSF mobile tent clinic, which had closed 30 minutes earlier
  • Death toll: This airstrike injured 9 people within the proximity of the tent clinic, including an MSF health educator and an MSF guard. One of the wounded people died of his injuries the following day.
  • Status: The clinic closed after the airstrike as the population felt MSF's presence caused the attack

Current activities

MSF has been working in 12 hospitals and health centres in Yemen, and providing support to more than 30 hospitals or health centres in 11 Yemeni governorates: Taiz, Aden, Al-Dhale’, Saada, Amran, Hajjah, Ibb, Sana'a, Hodaida, Abyan and Lahj, with nearly 1,600 staff including 82 international staff - making it among MSF's largest missions in the world in terms of personnel.

MSF resumed working in Hajjah and Abs hospital in November 2016. MSF supported the Al-Jamhouri hospital in Saada city with medications, incentives for their Ministry of Health staff and logistic support until December 2016, and is supporting the Shiara hospital in Razeh district with advanced care (emergency room and maternity).

MSF operations in Yemen had a budget of more than 103 million euros for 2015 and 2016.

Key MSF figures, March 2015-December 2016

  • Surgical interventions: 28,796
  • Emergency room patients: 396,032
  • War-wounded and wounded by violence: 56,202
  • Number of children admitted in paediatric unit: 20,939
  • Number of patients admitted: 36,774
  • General consultations for internally displaced people: 176,847
  • Deliveries assisted: 23,489

MSF projects

Saada

MSF withdrew its staff members from Al-Jumhori, Haydan and Shiara hospitals on 18 August because it considered them unsafe for both patients and staff after the bombing of Abs hospital on 15 August. The support to the hospitals never stopped though, and was in the form of medications, incentives and a referral system. MSF is currently supporting Shiara hospital with advanced care. MSF will resume its presence with international staff in February 2017 in Haydan.

Before the withdrawal of staff, MSF treated people with injuries from landmines, unexploded ordnance and other war wounds, as well as people injured in traffic accidents. MSF provided treatment to people in the maternity, surgical and inpatient departments, as well as providing mental health care and physiotherapy support.

MSF is currently providing assistance in the emergency room and in the maternity department of Shiara hospital. It  was hit by a missile-rocket in January 2016.

Hajjah: Staff were evacuated in August and resumed activities in Abs and Hajjah in late November 2016.

MSF withdrew its staff from Abs hospital and Al-Gamhouri hospital in Hajjah town on 18 August 2016 because it considered them unsafe for both patients and staff. As Abs hospital is run by the Ministry of Health, a minimum of medical activities continued despite the level of destruction of the facility, with the remote support of MSF, and both national and international personnel resumed working there in late November.

In Abs hospital, MSF is currently managing the emergency cases in the emergency room, the paediatric ward and the maternity unit. Teams are also providing support to emergency surgery with post-operative care. Mental health support for both patients and their caretakers is also available. In addition, MSF opened an inpatient therapeutic feeding centre (ITFC) in the hospital in early December. MSF refers complicated cases to the specialised hospitals in Hajjah, Sana'a and Hudaydah.

The population served by the project live all around the Abs district. Through a system of mobile clinics, MSF teams used to provide basic medical care to people while monitoring the nutritional situation. Mental health services were also provided through outreach activities for the population in and around the camps for internally displaced people. This mobile clinic programme will resume in late January.

In Hajjah town, MSF has been supporting the main public referral hospital in the governorate. Teams have been working in the emergency room, providing surgical services, and supporting in the intensive care unit and post-operative wards since August 2015, and the supporting maternity services since July 2016. MSF also supports a referral system to transfer patients to Al-Jamhouri hospital in Sana’a. 

Amran

The situation North Amran governorate is relatively calm; as a result people are fleeing conflict to settle in this area. MSF has been providing general consultations to displaced people through mobile clinics.

MSF is supporting Al-Salam hospital and Huth health centre via donations of medications and oxygen, logistic equipment and human resources, as well as ensuring a referral system.

MSF is donating medications, training personnel in emergency care, repairing and improving damaged structures, and running ambulance and referral systems in a number of health structures in Amran governorate. In January, MSF treated nearly 150 patients with scabies. In May, medical teams treated around 2,000 people with scabies after which it was decided to conduct a mass treatment campaign in Khamer and Huth.

Sana'a

MSF continues supporting the emergency room in Al-Kuwait hospital in Sana'a. In addition, MSF is donating emergency supplies to Al-Jumhouri and Al-Thawra hospitals. MSF provides war wounded kits in the districts surrounding Sana'a, like Arhab, Nihm, Hamdan or Jihanah. MSF is also supporting the mother and child hospital Al Sabeen in Sana'a.

HIV

MSF's support to the Ministry of Health's HIV programme in Sana'a continues as normal. More than 1,752 patients from the capital and several governorates received their life-saving anti-retroviral treatment in 2016 despite the tensions and violence in the city. And this intervention will continue throughout the year. In addition, MSF will keep supporting Voluntary Counselling and Testing as well as Prevention of Mother to Child Transmission sites, in parallel with its advocacy work for the rights of people living with HIV to fight the stigma and discrimination against them in health facilities.

MSF has been providing regular blood testing kits to the National Blood Bank in Sana'a since September 2015.

Dialysis

Between October 2015 and the end of December 2016, MSF supported dialysis treatment centres in Sana'a, Hajja and Mahweet and more recently the dialysis centre in Taiz (where there are around 650 patients with kidney failure). The International Committee of the Red Cross (ICRC) took over supporting these centres at the beginning of 2017, and MSF has now started supporting three dialysis centers in Sana'a. These patients were at risk of death as the dialysis treatment centres were badly affected by lack of supplies and had reduced their sessions per patient from three to two. MSF is supporting these centres until November 2017 but still needs to identify international organisations who are willing take over the support.

Mental health

In view of the escalating needs, MSF has progressively increased its mental health and psychosocial support activities across the country. The teams are composed of clinical psychologists and counsellors-educators, and the target population includes victims of violence and their families. Special attention is paid to war-wounded internally displaced people, and children. In 2016, MSF provided 5,700 individual and family sessions to over 2,700 affected people and their relatives, in addition to group interventions to sensitise local communities about mental health, reduce stigmatisation and teach basic techniques for psychological hygiene and to restore previous coping mechanisms; recreational activities for the children hospitalised are part of this package. Furthermore, regular training is provided to the medical staff in the MSF-run or supported hospitals in different regions, in order to improve the referral system and the understanding of the psychological effects of exposure to violence. Mental health teams are also actively involved in mass casualty contingency planning and implementation in all the projects.

Ibb

At the end of 2015, MSF initiated medical and humanitarian operations in Ibb governorate, the most densely populated region in the country bordering two active frontlines.

MSF supports the emergency department of Ibb governorate's tertiary-level referral hospital, the most important referral medical structure in the region with a catchment population of 2.5 million. The objective is the provision of free, high-quality emergency medical care to war-wounded and the general population, ensuring the hospital's capacity to manage a large influx of trauma cases (mass casualty management) and the provision of outpatient care for displaced people. The emergency room receives more than 1,000 patients per week, of which around 15 per cent are victims of violent trauma and 17 per cent are other critical cases.  Finally, MSF provides regular financial and material support to departments of the hospital.

Additionally, close to one of the country's frontlines bordering Taiz governorate, MSF currently supports the general rural hospital of Thi As Sufal district. MSF provides free, high-quality emergency medical care, life-saving surgeries, and inpatient hospitalisation for the most severe medical conditions. MSF also ensures the mass casualty management capacity of the hospital. On average, MSF teams undertake 250 consultations in the emergency room and perform 80 surgeries per week. The catchment population of this medical structure is estimated to be 500,000. Finally, MSF provides regular monthly donations to the maternity department, in addition to providing water, fuel and other support to the hospital.

Taiz

The situation in Taiz remains extremely critical, with some of the heaviest fighting in the country.

MSF is running life-saving medical activities on both sides of the frontline in Taiz, Yemen's third largest city, where most hospitals have closed due to the conflict. In the Al Houban neighborhood, we run a mother and child hospital where 458 deliveries were assisted last month. Over 2,500 severely malnourished children were admitted to the therapeutic feeding clinics supported by MSF in Taiz. MSF also runs a trauma centre for war-wounded and trauma cases and ensures referrals. In the enclaved city centre, MSF supports maternity services in Al Jomhouri hospital, paediatric services in the Yemeni Swedish hospital, emergency services in Al Thawra hospital, and treatment for war-wounded in Al Rawdah hospital. Most of the wounded come from the city centre, where many civilians are caught in the middle of intense fighting, and are struggling to find food and survive. The patients MSF sees in Taiz mainly suffer from injuries sustained through airstrikes, blasts, shellings, gunshots and more recently landmines. Movement in and out of the city remains restricted and dangerous for civilians and humanitarian actors. MSF is also providing medications to the emergency room and the emergency operating theatre of Khalifa hospital in Al-Turba in Taiz.

Al Dhale

Al Dhale governorate is located on the old border between northern and southern Yemen and besides being affected by the current conflict, it is also affected by ongoing tensions over the old border. The governorate has frontlines on three sides between pro-Hadi forces and pro-Houthi forces (Hamak, Taiz, Moreis/Damt).These areas saw intense levels of fighting in August in the form of armed clashes, snipers, shelling and rockets. Shelling along the frontline hit civilian houses and cars. There was an increase in civilian causalities as armed actors targeted villages. One incident in particular stood out when seven children aged between four and six were seriously wounded by shelling. They were admitted to the Al Dhale hospital, where two of them died.

MSF works in partnership with the hospital in Al Dhale and districts health centres in Al Azariq and Qatabah, running emergency rooms, and managing outpatient consultations, surgical interventions, inpatient services, patient referrals, paediatric care, nutritional programmes and maternity services. The Emergency Room of the health centre in Damth, the only MSF location under Houthi control in the governorate, is also supported by our teams.

Aden

Aden is currently controlled by southern resistance forces, backed by the military coalition led by Saudi Arabia. MSF is running an emergency surgical hospital in Sheikh Othman district, in the north of the city. The hospital provides free medical care in an emergency room, a hospitalisation ward and an operating theatre, and provides mental health and physiotherapy consultations. MSF is still seeing victims of landmines and unexploded ordnance coming from Aden, Taiz, Lahj and Al-Dhale’. A medical doctor and nurse conduct weekly visits to Aden Central Prison to provide primary healthcare services. An average of 50 consultations are provided every week.

Training

Training is a regular activity in this hospital and MSF provides on- the-job training to Ministry of Health doctors and nurses. We have one doctor and two nurses at a time. MSF started this activity in February and we have trained 14 doctors and nurses so far. An official training programme supported by the David Nott Foundation, validated by the Royal College of Surgeons of England, ran for three days in early July. Around 40 surgeons attended the course from hospitals in Aden, Lahj, Abyan, Lawder and Shabwa.

Blood bank

MSF provided 700 blood screening test kits to the national blood bank in Aden so it could restart its blood donation activities.

Lahj

MSF has been supporting Ibn Khaldoun hospital in Lahj with regular donations of medical supplies since December 2015, and Al-Razi hospital in Abyan since February 2016. The support includes medications to the emergency room, and emergency operating theatre supplies to Lawadar hospital and Al-Razi hospital in Abyan.

Hodaida

MSF started supporting the emergency room in the Ministry of Health Al-Olfy hospital in Hodaida with medications and medical supplies. The support also includes incentives for 60 of the staff.