Yemen: A daily challenge for MSF to adapt its activities

How have MSF’s activities evolved in North Yemen? Médecins Sans Frontières (MSF) has worked in Saada governorate in northern Yemen since September 2007, providing medical care to the population affected by the conflict that began in 2004 between government forces and Al Houthi group. MSF supports two Ministry of Health hospitals, in Shara’a (Razeh district) and in Al Talh (Saher district). In both hospitals, our teams provide free medical services carrying out primary health care and emergency consultations, hospitalisations and gyneco/obstetrical activities. In Al-Talh, surgery is also performed for emergency cases. In surrounding towns around Razeh and Al-Talh, MSF supports ministry of health structures by providing consultations and hospital referrals. After the sixth war started on August 11, 2009, MSF also began to provide assistance to displaced populations in Mandabah area, north of Saada governorate. A water supply system was created to provide drinking water for around 250 families. During the past two months of intense fighting, running all these activities has become increasingly complex, despite the authorisations that we have from both sides. We had to temporarily stop surgical activities in Al Talh and have reduced the support we provide to primary health structures. Also, we had to delay the beginning of medical activities in Mandabah area. However in Razeh, consultations and hospitalisations are ongoing and our teams perform around 560 emergency consultations per month. An MSF surgical team will soon reinforce this hospital. How would you describe the main needs of the people in Saada governorate today? The continuous fighting has forced large numbers of people to flee repeatedly inside the governorate or towards neighbouring governorates. It has been difficult to obtain precise figures on the overall number of displaced as rescue teams and humanitarian actors have difficulties reaching all areas of the governorate. However, according to UN figures around 60,000 displaced people have so far been registered in Saada, Amran and Hajja governorates. In addition, families are still on the move, travelling from one location to another in fear for their safety. For example, in the north of the governorate some families were displaced from Dahyan towards Jesnem, then from Jesmen towards Baqim, and then from Baqim towards Mandabah. But even in Mandabah, finding a safe place was extremely difficult as clashes erupted there and families were scattered once again. In Mandabah, our teams had assessed the situation of around 3,000 people, mostly living in precarious conditions, with poor access to water and lacking of basic items (blankets, cooking equipment, etc). Food has also become a serious concern as difficulties in supply made food prices rise to almost four times more than normal. As other actors are focusing on the distribution of food and non-food items, the objective for MSF is to provide medical care for the population of this area. Healthcare access in the governorate is definitely an issue, as most of health structures are not functioning anymore and others are very difficult to access for the population. It remains difficult to estimate the number of civilian casualties. In Al Talh hospital between August 11 and September 2, 2009, MSF carried out 195 surgical interventions - 135 were for war related cases. Afterwards, surgical activities had to be interrupted in Al Talh hospital. MSF is working with the Yemeni Minister of Health in order to restart these activities as soon as possible. How has MSF continued its activities in such difficult security conditions? It has been a daily challenge considering that we faced numerous problems, namely insecurity and lack of communication. All land and wireless telephones have been unreliable, roads linking Saada governorate with the rest of the country have been blocked and MSF national staff have often been working in hospitals without contact with their families. MSF adapted to the situation by sending medical supplies and human resources [notably a surgical team] through Saudi Arabia, and following up very closely the evolution of context. It is worth mentioning that all actors of this conflict understand MSF principles of neutrality and impartiality. As a result in Razeh and Al-Talh, we managed to treat any person in medical need – including war wounded cases – regardless of their political affiliation. Between January and July 2009, in Saada governorate, MSF teams carried out 30,000 consultations of which 8,000 were for emergencies and with 1,450 hospitalisations. MSF also performed 720 surgies, around 100 of them for war injured.