The conflict and the recent escalation from the warring parties has increased the vulnerability of the Yemeni people. Médecins Sans Frontières (MSF) not only provided lifesaving care to people injured in these outbreaks of violence, but also treated patients suffering the long-term effects of war, such as mental health, malnutrition and difficulties in accessing essential services, such as mother and child care.  

Direct impacts of the war 
During 2021, we sent teams to treat war-wounded patients across the country, from Mocha in the west to Marib in the east.  

Our hospital in Mocha responded to multiple mass-casualty incidents in November, as the frontline south of Hodeidah, where Ansar Allah is fighting a coalition of armed groups allied to the government, saw intense fighting.  

The violence in Marib between Ansar Allah and Yemeni government forces was particularly fierce, forcing thousands of people to flee their homes. The camps where they settled often lacked basic necessities such as food, water and adequate shelter. In March, we launched an emergency intervention in Marib general hospital and worked throughout the year to increase its capacity to deal with frequent influxes of war-wounded and other trauma patients. 

Our teams also saw increasing numbers of people with mental health issues caused by the fighting and its associated stresses and traumas. To respond to the needs, in May we opened a new specialised mental health clinic in Al-Jomhouri Authority hospital, in Hajjah city, where we provide psychoeducation, counselling and psychotherapy, as well as psychiatric care for people with severe mental health conditions.  
 
Mother and child care 
Timely access to safe and good-quality medical care for expectant mothers and newborns is a major issue across Yemen, with needs vastly exceeding available resources. In Hodeidah governorate, we started running Al-Qanawes mother and child hospital in December 2020, providing maternity services, including caesarean sections, inpatient neonatal care and mental health support. In Abs General hospital in Hajjah, we continue to support the emergency room, the paediatric and neonatal wards, the maternity unit which sees over 1,000 deliveries per month, and the inpatient therapeutic feeding centre. 

MSF has been running a mother and child hospital in Taiz Houban since 2016, offering trauma stabilisation care, maternity services for high-risk and complicated cases, paediatric and neonatal inpatient care and inpatient therapeutic feeding. In Taiz city, to respond to the need for specialised reproductive healthcare services, we started to manage maternal and neonatal care in Al-Jomhouri hospital from June 2021, in collaboration with the Ministry of Health. This refocus of activities meant that we ended our support to the city’s Yemeni Swedish children’s hospital and Al-Thawra hospital. 
 
Malnutrition  
In Abs, Hajjah governorate, our teams treated an alarming number of children suffering from malnutrition. Our inpatient therapeutic feeding centre operated at more than 100 per cent capacity throughout the year, and our teams treated many more children with severe malnutrition and medical complications than the year before.  

Other MSF projects in the northern part of Yemen, such as in Ad-Dahi in Hodeidah, Haydan in Sa’ada and Khamir in Amran, also recorded slight increases in the numbers of malnourished children treated, although they were not as significant as in Abs.  

Much of the malnutrition that we see in Yemen is caused by a lack of access to basic healthcare for children – if children become ill and cannot get the treatment they need, they are much more likely to become malnourished. Inflation is also making it increasingly difficult for Yemenis to feed their children and afford the cost of transporting them to hospital, which contributes both to malnutrition and the late treatment of illnesses.  
 
COVID-19 
The COVID-19 pandemic continued to have a severe impact on Yemen in 2021, with peaks of the disease early in the year and again towards the end of the year.  

We managed treatment centres in Sana’a, Aden and Ibb, where we ran some of the country’s only intensive care units. Death rates were high, and we know that many people in remote areas were unable to obtain treatment because it was not available locally, and they could not afford to travel to the cities where we were working.  

Rumours and misinformation about COVID-19 circulated freely, exacerbating fears of the disease and stigmatisation of those infected with it. Moreover, the Ansar Allah authorities continued to refuse to address the spread of the virus publicly. Their refusal to use the vaccines, combined with other factors, such as issues with the supply of doses and the roll-out of vaccinations in government-controlled areas, as well as public distrust, meant that Yemen had one of the lowest rates of COVID-19 vaccination in the world in 2021.  

An inefficient humanitarian response 
MSF continues to call for a radical overhaul of the aid system in Yemen. Despite the large amounts of money spent on the humanitarian response, much of the international aid continues to be inefficient because it lacks both the flexibility to respond effectively to emergencies and the planning to ensure the provision of healthcare over the long term.  

The authorities in Yemen also need to do much more to support and facilitate the work of humanitarian organisations. Limits on humanitarian action are too severe and are preventing the timely and independent provision of humanitarian aid where it is needed most.