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“Some families have to choose between taking a child to hospital or feeding the others”

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MSF project coordinator Roger Gutiérrez is back from seven months in Abs, Yemen where he helped re-establish health services after the town’s hospital was hit by an airstrike in August 2016. Here, he tells how repairing the physical damage was relatively simple,  but rebuilding people’s confidence has been much harder.

In Abs hospital, the wards are bursting at the seams, as our medical teams do everything they can to meet people’s urgent health needs.

What’s happening in Abs sums up the current state of Yemen. More than two years after the conflict escalated, the country has been torn apart. Many health facilities are not functioning, or lack staff and medical supplies, and the health system has collapsed.

Abs is in Hajjah governorate, near the border with Saudi Arabia and close to frontlines. The region shelters tens of thousands of displaced people. Some  families have been displaced two or three times already; they have suffered the trauma of losing family members to the bombing and fighting, of leaving their homes, jobs and social networks behind in the hope of rebuilding their lives from zero.

At first, it seems surprising that some have chosen to resettle in remote locations, far from public services such as schools, health centres – even from water sources and markets. But this is because they are afraid. They see crowded areas as places that might be targeted by violence, and so they have chosen to prioritise the safety of their families over access to services.

When a plane flies overhead, many patients and staff feel that fear, that vulnerability. For seconds everything stops. You see mothers disconnecting their children’s feeding tubes so they can run out of the hospital's nutrition ward. The bombing of the hospital in August 2016 not only destroyed the building, it also destroyed people’s confidence. Rebuilding that trust has taken months.

Gradually, since MSF teams returned to Abs last November, our health services have become known and trusted again. This is evident by the 20 per cent increase each month in emergency cases, and the fact that we are attending more than 250 births each month – even more than in Hajjah, the capital of the governorate. People arrive at the hospital after travelling for hours to access surgical services, or after driving 70 or 80 kilometres to be treated for basic illnesses like malaria.

Seeing the relevance of our teams’ work justifies all our efforts to make our humanitarian principles – such as the neutrality of our health services – understood. Since the return of our teams to Abs, we have had to communicate a lot with all parties to the conflict, and we have to inform them of our plans long in advance. This forces us to plan our movements up to a week ahead – a challenge for an organisation that aims to respond to emergencies as quickly as possible.

Abs is a small town in a rural area that has seen its population increase in recent years. Services run by authorities have totally collapsed and there are hardly any other organisations providing even basic services to all these people. As a result, there has been an appearance of epidemics of both infectious and non-infectious diseases that should be controlled or limited – such as whooping cough, malaria and, more recently, the explosive outbreak of cholera.

Poverty is also widespread. Many patients tell us that they have very limited means, which forces them to make difficult decisions, such as whether to spend what little money they have  on taking a sick or malnourished family member to hospital, or use it to feed the rest of the family.
In Abs, MSF treats people with injuries from the war, but most of our patients are civilians. We are like a bubble in the middle of the conflict, providing assistance to the most vulnerable, especially women, children and the elderly. People often have difficulty reaching the hospital, because they can’t afford to buy petrol or are unable to find any transport. There are other hurdles, such as insecurity from the bombing and fighting, and the deterioration or destruction of essential infrastructure like bridges and roads, either as a result of the war or because of the rainy season.

Despite these obstacles, patients continue to arrive. The bombing put MSF on the map. People know that we were forced to leave, and that we came back with a firm commitment to help the people who needed us. The overcrowding of all our departments is a symbol of that trust, but also, unfortunately, an indication that there is hardly anyone else providing assistance in a place with many needs and a very uncertain future.

MSF began supporting Abs rural hospital in July 2015. On 15 August 2016, an airstrike hit the hospital, killing 19 people, including one MSF staff member, and wounding 24 others. Shortly afterwards, MSF withdrew its teams from a number of health facilities in northern Yemen. In November 2016, MSF resumed its support to Abs hospital; currently MSF has some 200 Yemeni staff and 12 international staff working there. MSF manages the hospital’s emergency room, paediatric unit, maternity ward and nutrition centre, and provides mobile clinics and psychosocial counselling sessions.