A critical shipment of medicines bound for a hospital in Hodeidah, Yemen, arrived this week, a sign that aid deliveries into the country are resuming. The shipment was coordinated with local aid group, Yemen Aid, and includes IV fluids, antibiotics and other items used to treat cholera. The shipment will bolster the Al-Thawra Hospital in Hodeidah, where Direct Relief is target efforts to help stem the tide of cholera. The hospital is one of many on the front lines of the epidemic.
— Yemen Aid US (@YemenAid_US) December 12, 2017
Hodeidah is a governorate that accounted for more cholera cases in 2017 (135,000) than were reported by the World Health Organization across the entire world during 2016 (132,000.)
The specific reason for this remarkably rapid spike has still not fully been absorbed, but hinges on severe damage to water and sanitation infrastructure, destruction of health facilities and sharp curtailment of the flow of people and goods into and out of war-torn communities.
The cholera epidemic in Yemen, now one of history’s fastest spreading, began a little over a year ago, in October 2016. The country’s civil war was over a year-and-a-half old at that point. A report on Oct. 6 from health officials in the country’s capital city of Sana’a indicated that 11 of 25 acute diarrheal disease cases had just tested positive for the presence of cholera. This was sobering news given the severely damaged conditions of health and sanitation services throughout the country, and the significant challenges posed to the movement of goods and people across the war zones, but it was not evidence enough in itself to forecast what would happen over the next year.
What began as 11 cases in the capital city in the fall of last year spread to over 35,000 cases over dozens of districts by late spring of 2017.
On May 22, the number of cases began a dramatic trend upward.
From then until the beginning of November, cholera has spread like wildfire throughout the country. That serious outbreak of 35,000 cases metastasized into a world historic event, with Yemen’s millionth suspected cholera case expected to be announced sometime before the end of 2017. Almost every populated area of the country has been touched by the disease, most particularly the densely settled coastal areas along the Gulf of Aden.
That shipment from Direct Relief, much like those of dozens of other aid groups, was delayed over the past few weeks by the imposition of a blockade on Yemen’s borders imposed by the government of Saudi Arabia.
Although the blockade on humanitarian goods has been partially lifted, allowing shipments like Direct Relief’s for cholera response to enter the country through two seaports or via UN air transport into the airport in Sana’a, the blockade remains in place for non-humanitarian shipments of goods. This remains a critical problem, given that over 80 percent of all food and medicine consumed in Yemen must be imported. The United Nations and other international agencies are calling for the blockade to be lifted entirely so as to avoid famine among roughly 8 million of Yemen’s 25 million citizens.
Famine is by no means a “natural” or inevitable occurrence. In the case of Yemen, it is the specific consequence of war tactics, which prevent citizens from accessing basic goods and services, placing them, in effect, into a state of siege.
In addition to the cholera outbreak and potential famine, Yemenis are increasingly at risk of additional infectious spread, including measles and a recently detected outbreak of diphtheria. Nearly 200 cases of diphtheria, a serious respiratory illness that can result in paralysis and death, have been reported as of Dec. 1. Diptheria and measles are both vaccine-preventable diseases, which disproportionately affect children. One of the key reasons they are spreading now is that vaccines, like other goods, have been prevented from distribution to health centers and hospitals, which would ordinarily conduct childhood vaccinations. With at least the humanitarian blockade lifted, now is a crucial time to ensure that these other infections do not spread the way cholera has over the past year.
Turning the Tide of Cholera
As terrible as this year has been for Yemenis afflicted by war, disease and poverty, there have been important, but underreported, signs of progress as well. One of the most significant is in the capital Sana’a, where the outbreak began. Sana’a’s case totals were on a steady linear ascent, similar to many of the surrounding governorates, when in late summer of this year an enormous acceleration occurred. Aid was mobilized relatively quickly, including a widespread awareness campaign, and that huge spike was blunted. Cases continue to increase, but at a much slower pace than would have occurred in the absence of timely action. By the end of August, the UN was reporting reductions in cholera incidence, and not only in Sana’a.
Perhaps even more important has been the total flattening out of death totals from cholera in Sana’a. Since this past August, not one death from the disease has been reported in the capital, indicating again that timely medical intervention works. With the year coming to a close and the winter months holding additional challenges, it is vital that we in the international humanitarian community do all that we can to build on the successes that have occurred in Yemen, and make sure that 2018 represents a year of recovery and rebuilding rather than a year of famine and worsening epidemics.