Yemen: Driving ARVs through a city under siege

Abdulbaset Alzamar is a Yemeni nurse working with HIV positive patients with MSF and the Yemen Ministry of Health. He talks about his experience providing live-saving ARV treatment to patients as unrest tore the capital, Sana’a, apart.

In late 2010 and the beginning of 2011, the situation in my country started to deteriorate. First, there were the demonstrations and protests in the capital, Sana’a; then violent clashes broke out all over the country.

At the time, I was working for MSF and the Ministry of Health at the HIV clinic in Al-Gumhuri hospital, the only facility in Sana’a that provides live-saving antiretroviral treatment to patients suffering from the virus.

It was clear to us that we needed to be prepared for the worst. With more than 350 patients receiving live-saving ARV treatment at our facility, we needed to put a plan in place that meant we could continue to get drugs to patients if conflict broke out.

In Yemen, getting treatment for HIV is already difficult.  As a general rule, HIV positive patients find getting tested and treated for the illness very difficult because of the stigma associated with it. They’ve been misinformed about the disease, and have lived their whole lives seeing how HIV positive people are discriminated against – even by health workers. Even I personally had misconceptions around HIV until I trained as a nurse, and learned the science behind it. 

Getting treatment for HIV is difficult

In spring 2011, the fighting intensified and Sana’a was divided into two sides. Different armed groups took over sections of the city, and moving around became extremely difficult. Clashes around the hospital meant the staff were trapped inside for three days. The situation became too dangerous for foreign staff to hang around – they were all moved to safe houses and flown out of the country.

But most of the Yemeni staff – myself included – stayed on. Though we could no longer run our regular activities at Al-Gumhuri, we still needed to get ARV drugs to the HIV patients, or else their condition could deteriorate, and they could even die.  So we put our well-laid plans into action.

In the months leading up to the conflict, the MSF and Ministry of Health staff had given special cards to each of our patients. The cards were a way for patients to get in touch when they needed their medication delivered, should we have to suspend our normal activities. These health cards didn’t have any information on them that could identify them or me – they had my phone number on it, and that’s all.

"People would call me day and night"

The patient would call me and give me their patient number. From that number, I’d know what kind of drug regimen they were on and I’d be able to collect the appropriate ARVs from storage. The patient would then give me a location, and I’d either take my car to drop the appropriate ARV medication off there, or I’d leave it – tucked discreetly into a shopping bag – wherever they requested. Doing this, I visited some pretty unusual locations – I once was asked to leave the drugs in a supermarket; another time, a photographer’s studio.

 Sometimes patients would even come to my home and collect the drugs that they required; or I’d pick them up in the street, give them their drugs while I drove, and then drop them off in another location so as to avoid putting ourselves in danger. People would call me day and night; I had no idea how long this was going to go on for, so at times it seemed like it would never end. It didn’t matter to me how it happened, though. All that mattered is that the sick people got treated, even while the two sides of the city were on lockdown.

Early on, it became clear that we were going to have to move the stores of drugs. We had originally planned to keep them at the in the National AIDS Programme facility in a central part of town. As it happened, though, that area became the scene of consistent heavy fighting, and it wasn’t safe for me to be going in and out. We agreed that the best thing to do would be to take all those medications and move them to family home.  Once, as I was leaving the facility, there was a huge explosion – a bomb went off near my car. I was fine, but it shook me – I had no idea it was coming.

Divided along political lines

The city was divided along political lines, and crossing frontlines to make deliveries was tough. I constantly got questioned at checkpoints, as each side was concerned that I may be supporting the other. Of course, MSF is a neutral humanitarian organisation that treats everybody, regardless of any kind of affiliation or belief; but you try telling that to the man with the automatic weapon! Sometimes my wife and two children would come with me – if I had my family in the car, we wouldn’t be stopped.

After three months, the active fighting came to an end, and we were able to resume full activities in Sana’a. And for all the hard work, the plan was a success: we were able to reach all of the 363 patients needing ARV treatment during the fighting, with 97 per cent of them coming back to us to continue their treatment after it was over. There were some scary and stressful times, but I never felt like it was too much for me. In fact, the patients became like family to me – I was often the only person they could trust. I hope there will never again be unrest like this in my country. But if ever there is, we’ll be ready.

Research documenting MSF’s successes in delivering HIV care in conflict-affected Yemen, along with other humanitarian research, was presented at MSF Scientific Day in London on 23 May 2014.  The Yemen presentation will be available to watch again at msf.org.uk/msf-scientific-day.