Day 6

Yemen is now home to the world's worst humanitarian crisis

Yemen is suffering through what UN representatives are calling "the world’s worst humanitarian crisis." Médecins Sans Frontières' country director explains how he navigates a civil war and a major cholera outbreak while MSF's own people come under fire.
Yemenis sit on the debris of a house hit in an air strike in the Faj Attan district of the capital, Sanaa, on August 25, 2017. (Mohammed Huwais/AFP/Getty Images))

The conflict in Yemen shows no signs of abating anytime soon. The country is in the third year of a crippling civil war between the Iran-backed Houthi rebels allied with former president Ali Abdullah Saleh, and forces loyal to ousted president Abd-Rabbu Mansour Hadi.

Since 2015, Saudia Arabia has led a U.S.-backed military intervention against the Houthis, with the aim of reinstating Hadi.

Caught in all this are the people of Yemen. As bombs fall all around them, food and water continue to be scarce, and a cholera epidemic has infected more than half a million Yemenis and killed nearly 2,000.

The UN is calling it "the world's worst humanitarian crisis." This week, 62 NGOs sent a letter to the UN calling for an investigation into airstrikes that have destroyed schools and hospitals.

Recently, a photograph of a survivor of an air strike on Yemen's capital, Buthaina Muhammad Mansour, believed to be only four or five years old, went viral, sparking outrage over the brutality of the ongoing war. The young girl suffered facial injuries and a broken skull after an Aug. 25 air strike destroyed the Sanaa apartment she lived in with her family, who were all killed in the blast.

Buthaina Muhammad Mansour sits on a hospital bed after surviving a Saudi-led airstrike that killed eight of her family members in Sanaa, Yemen, on Aug. 26, 2017. (Khaled Abdullah/Reuters)

On Thursday, the family of the founder of humanitarian organization Red Crescent said he had died after being denied access to life-saving treatment in Sanaa. Abdullah Alkhamesi, 76, was one of Yemen's leading doctors, whose group saved countless lives since its establishment in the 1970s.

He was just the latest victim of conditions on the ground in Yemen, which according to the UN have left more than half of the country's health facilities unable to operate. The UN has also estimated that the closure of the airport has meant that 20,000 patients have been denied potentially life-saving treatment abroad.

All this puts medical workers in a difficult position — while working under such difficult conditions, they're also potential targets. And yet, they have to stay impartial.


A medical tent with cholera patients in the cholera treatment centre managed by MSF in a school in Abs town, next to the Abs Rural Hospital. (Medecins Sans Frontieres)

On the frontlines

Médecins Sans Frontières (MSF) has been working with 18 hospitals and health centres across Yemen. "We remain neutral in the conflict," Justin Armstrong, head of mission for MSF, tells Day 6 guest host Peter Armstrong. "When we speak out, we speak out about the needs of the population and civilians. And so as long as we remain straightforward about what we offer and transparent in what we do, we can get access to some very difficult places."

Armstrong, who is based in Sanaa, says life for everyday Yemenis has been thrown into complete disarray by the conflict.

"You see millions of people displaced from their homes, seeking safety," he explains. "The economy is struggling massively, on the verge of collapse. Many people struggle to make ends meet.

"Four different MSF health facilities have been hit in the course of this conflict.- Justin Armstrong, Head of mission for  Médecins Sans Frontières in Yemen

"And for us as a medical organization, we see firsthand the impact on the healthcare system where hundreds of health facilities have been closed, dozens have been destroyed and the others that are still functioning are very much struggling with no funding, no salaries, and growing overwhelming health needs."

A big part of the challenge for health providers is the ongoing cholera epidemic, Armstrong points out. MSF has opened 22 cholera treatment centres across the country, and other organizations are doing their best to address the outbreak as well, "but it has been a struggle to build that capacity quickly to respond," Armstrong says.

"It started to take off in late April and sadly the response was not as fast as it should have been. It has picked up speed up as the outbreak has grown… but for many humanitarian organizations, cholera is something that they do, or should, have experience with and they should be able to provide adequate treatment."

VIDEO: MSF is running a cholera treatment centre in Abs town, in a hospital that was hit by an airstrike in August 2016.


Struggling to survive

Cholera is but one of the myriad health issues facing Yemenis — in addition to injuries and death from air strikes and other violence, people are dying of otherwise preventable causes due to the collapsing economy and lack of facilities.

"We see women needing assistance in childbirth, childhood vaccination programs struggling," Armstrong says. "The absence of safe water and decent sanitation in much of the country is a major issue and something that has a direct impact on people's health."

Yemen's economic nosedive plays a direct role in health outcomes and the lack of medical facilities, Armstrong notes. With civil servants not receiving salaries for the past year, many were forced to look for work elsewhere.

"Waste management and sanitation is a major struggle here and has played a significant role in the recent cholera epidemic," he says, "But then you also see other government functions — administrative things — struggling to really keep afloat, offices closing, and just making everyday life that much more difficult for your average Yemeni."


In October 2015, the Haydan hospital in northern Yemen, supported by MSF, was hit by several airstrikes. (Médecins Sans Frontières)

Direct impact

On top of the difficulties of trying to administer medical care in Yemen, health officials there also face being a target themselves in the midst of the conflict, but humanitarian groups like MSF remain on the ground to try to help where they can.

"Four different MSF health facilities have been hit in the course of this conflict over the last two-and-a-half years, as well as dozens of others," Armstrong says. "So we are definitely seeing that impact firsthand. We have lost staff and patients in our facilities. And we definitely see the need for greater respect for the neutrality of medical care and respect for the right of Yemeni civilians to seek medical care and humanitarian assistance."

Damage inside a hospital operated by Medecins Sans Frontieres after it was hit by a Saudi-led coalition air strike in the Abs district of Hajja province, Yemen in August 2016. (REUTERS/Abduljabbar Zeyad)

Despite the images of bombed-out buildings and civilian casualties coming out of Yemen, its people remain resilient, Armstrong marvels.

"Yemenis are remarkable," he says. "It is astounding, coming in from outside and seeing that people do find a way to get by and to survive. Obviously many are in very, very difficult situations over the years of intense conflict. They've exhausted savings, they've taken loans from friends... They've done everything they can to keep them afloat and keep their family safe.

"And people do find a way," he continues. "But it is just getting more and more difficult by the day for people here."


To listen to the full interview with Médecins Sans Frontières' Justin Armstong, download our podcast or click the 'Listen' button at the top of this page.