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Health care workers face a double battle – COVID-19 in a conflict zone
2 July 2020 – Dr Sami Al Hajj is a young doctor working at Science and Technology Hospital in Sana’ where he lives with his pregnant wife. Every day, he puts himself at high risk at his job.
“COVID-19 has left Yemen and health care workers on the frontlines under severe pressure. We put our lives at risk to save the lives of our people. I have seen many doctors fall sick and be admitted to be put on ventilators and monitors, or worse, die. This has been the hardest thing to witness,” he says.
Yet Dr Sami shows no sign of giving up.
“The sensitive health situation in Yemen has made me grow. It made me aware of the magnitude of the needs in Yemen, and of my role to play as a health care worker,” he adds.
We are in this together
As the COVID-19 pandemic emerged in Yemen, Dr Sami received calls and messages from many people on social media worried about the virus and what it meant to them and their families. This made him think of the people working on the streets who don’t have phones or internet and who need medical guidance.
So he decided to start a unique initiative. He printed a poster offering people in the community to stop him for a free consultation if they needed to and placed it at the back of his car.
“People are scared. Many are unable to stay quarantined due to their financial situation. So they go out to their jobs knowing they are at high risk of infection. I wanted to be closer to them – easier to reach – whenever needed, to discuss a medical issue,” he said.
“I was quite surprised at how people reacted to the poster. It made me happy. In the more disadvantaged areas, I would have 30 people stop me in one day.” He adds. “Of course, I am not providing medical services, all I am doing is providing medical consultation services and referring them to the medical facilities where they can access medical support.”
This initiative reminded Dr Sami of the importance of the role health care workers play in the community, especially during a pandemic.
“I understand the fear of health care workers. It is a justified fear given the deteriorating health situation. But our people need us and our experience. I urge myself and fellow doctors to work this out together and to support each other during this challenging time to survive the pandemic.”
The risk COVID-19 poses to Yemen is unparalleled
Since the spread of COVID-19 in December 2019, the pandemic posed an unprecedented impact to health systems worldwide sustaining a dramatic rate of global transmission and spread of cases. The risk it poses to public health in Yemen, however, is unparalleled.
The health situation in Yemen has already been undermined by over 5 years of ongoing conflict and existing vulnerabilities before the war, which have caused extensive damage to the infrastructure and left the health system in Yemen unable to carry the load.
Only half of the health facilities in Yemen are fully functional, and those operating are under severe shortages of essential equipment, supplies and medical staff. Successive infectious disease outbreaks, such as cholera and diphtheria, continue to ravage the country and push more people into vulnerability. High rates of malnutrition among adults in the country is another alarming indicator of the compromised immunity and the vulnerability of the population to infectious diseases. Internally displaced people and refugees are among the most vulnerable due to poor access to sanitation services along with insufficient hygienic practices.
Health care workers need us now more than ever
As evidenced by this pandemic the health care workforce is the backbone of any health system—these are the unsung heroes.
In Yemen, there is a huge lack of skilled health workers. And those who are available are vulnerable: there are no doctors in 18% of districts across the country and most health personnel have not received salaries for at least 2 years. This is in addition to the insufficient number of nurses and midwives coupled with weakened medical health education, unable to fill the deficit in human resources for health, compounded also by the brain drain where the most skilled health professionals have left the country for better opportunities abroad. Based on the existing knowledge of the health care workforce structure in place, medical and paramedical staff lack training on case management, infection prevention and control and use of personal protective equipment to face COVID-19.
The unprecedented financial gap faced under the Yemen Humanitarian Response Plan has led to a fiscal cliff that is threatening the ability to provide a living wage for over 10 000 health care workers who staff Yemen's functioning hospitals and health facilities.
Dr Sami is proof that one person can make a difference. This act of solidarity echoes the message of WHO—the only way we can beat COVID-19 in Yemen is if we do it together.
WHO and aid agencies continue to ramp up COVID-19 response efforts reaching more than 16 million people with awareness-raising activities, and supporting health workers across Yemen with over 227 500 units of personal protective equipment, including gloves, aprons, face shields and masks. In addition, the United Nations has been providing living wages to 9000 frontline health care workers who would otherwise be unable to support their families due to the ongoing conflict.
Government of Japan joins forces with WHO to strengthen mental health care system in Yemen
Yemen, July 2, 2020 – A new US$ 3 million contribution from the Government of Japan will give mental health and psychosocial support a fresh boost of support in health facilities across Yemen. The generous and continuous support of the Government of Japan plays a critical role in supporting WHO’s humanitarian response in Yemen, with donations amounting to more than US$ 11.5 million between 2015 and 2020.
Over 5 years of ongoing conflict have taken their toll on the mental health of the Yemeni people. Hundreds of thousands have been impacted by psychosocial stressors caused by war, poverty, illness and family separation, yet few have access to basic services and employment opportunities as the country goes through hardship.
COVID-19 comes as a new emergency on top of an emergency. People with existing mental health conditions and psychosocial problems are worsened by the impact of the COVID-19 pandemic. In populations already heavily affected by years of war such as Yemen, issues of service access and continuity for people with developing or existing mental health conditions are also now a major concern.
Mental health care services in Yemen
In Yemen, the mental health care system suffers from a shortage in funding, low commitment of decision-makers in advocating for such services, scarcity of mental health professionals, compounded by pervasive social stigma associated with mental health illness and the limited interest from humanitarian actors in strengthening mental health and psychosocial support systems.
Health authorities have limited capacities and resources as there are only 45 psychiatrists working in the country (36 in Sana’a and 9 psychiatrists in Aden (one psychiatrist to every 700 000 individuals). Also, the vast majority of people requiring treatment, including psychotropic drugs, have to pay for treatment.
This new injection of support will include strengthening mental health governance and human resources development. Furthermore, it will allow WHO to ensure that capacity-building, support and supervision are addressed in coordination with health authorities.
WHO response to the mental health crisis in Yemen
In 2019, WHO supported more than 14 000 mental health consultations, providing with its partners more than 90 000 psychosocial support sessions.
176 health facilities provided mental health and psychosocial support to those in need, including 47 hospitals, 63 health centres and 60 health units.
Note to editors
The 2020 Yemen Humanitarian Response Plan requires US$ 2.41 billion to assist more than 24.3 million Yemenis, which accounts for 80% of the entire population with humanitarian aid and protection. In 2020, WHO requires US$ 234.4 million to continue delivering its life-saving programmes. To date, the funding gap at WHO remains above 90%.
For more information, please contact:
Inas Hamam
Communications Officer
WHO Regional Office for the Eastern Mediterranean
Muneerah Al-Mahdli
Communications Officer
WHO, Yemen
WHO and KSrelief join forces to preserve the health system in Yemen
30 June 2020 – Over the past 8 months, WHO and the King Salman Humanitarian Aid and Relief Centre (KSrelief) have joined forces to ensure access to health care for the vulnerable in remote areas through the provision of a minimum service package. The support has enabled WHO to sustain the health system at primary and secondary levels, by allowing 293 facilities to remain functional and provide health access to 4.3 million people.
This support has also allowed WHO to prioritize the procurement and delivery of lifesaving medicines, including treatment for patients with chronic life-threatening conditions, through which more than 110 340 dialysis sessions were delivered to 5500 patients at risk of kidney failure, contributing up to 50% of the total costs of the dialysis sessions among all 21 centres available in the country.
The partnership between WHO and KSrelief has supported immunization of 65 673 children with pentavalent vaccine against (diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type b) at fixed health facilities across the country. Moreover, nearly 94 352 women were assisted for safe birth deliveries and 23 198 caesarean sections allowed women to safely deliver. WHO was also able to provide over 160 534 major and minor surgeries.
As KSrelief has been the main funding partner of WHO in 2019–2020, their generous donation supported up to 72% of more than 4 million total consultations reported between October 2019 and May 2020.
Though much has been accomplished, more needs to be done to secure Yemenis’ right to health and to save many more lives, now more than ever with the added burden and unprecedented threat of COVID-19.
Now more than ever Yemen’s health system needs support
More than 5 years of humanitarian crisis have turned Yemen into the world’s worst humanitarian crisis, with more than 80% of the population, approximately 24 million people requiring some form of humanitarian assistance and protection. The crisis has crippled an already ailing health system, with only 51% of health facilities fully or partially functional with an acute shortage of trained staff, medicines, equipment, fuel and water. This has left Yemeni people’s right to health hanging by a thread, as nearly 19.7 million are in need of health care access. And now, the already vulnerable people of Yemen are faced with the added threat of COVID-19. With wealthy countries struggling to contain the virus, in Yemen the added burden on medical facilities could result in a catastrophic death toll.
Noncommunicable diseases are a silent burden on the people of Yemen
Sameer, 60-years-old, receives dialysis treatment at Al-Sadaqa hospital in Aden
30 June 2020 – Esam is only 16 years old and he battles colon cancer. Esam receives treatment at the national oncology centre in Sana’a governorate, supported by WHO.
“I am hopeful. I’m looking forward to a time when I am feeling better so I can lead a normal life like my friends,” he says.
Patients who suffer from chronic diseases lead a challenging life. The additional burden of not being able to access or afford treatment is unimaginable. An estimated 35 000 cancer patients (10% of them children) and more than 1 million people who suffer from noncommunicable diseases (NCDs) are in need of humanitarian aid.
Sameer is 60 years old. He receives dialysis treatment at Al Sadaqa hospital in Aden. “Being a dialysis patient during this time in Yemen is agonizing. It is crucial that this support continues so we continue to have access to the sessions our lives depend on,” he says.
WHO and KSrelief are procuring up to US$ 24 million worth in supplies to cover the life-saving treatment needs of patients living with chronic life-threatening conditions such as cancer, kidney failure and NCDs, including diabetes. Up to 110 340 dialysis sessions were delivered to 5500 patients at risk of kidney failure between October 2019 and May 2020. This generous support from KSrelief contributed to up to 50% of the total costs of the dialysis sessions among all 21 centres available in the country.
Patients with chronic, life-threatening diseases need access to treatment
If over 5 years of war, ongoing armed conflict and being the worst humanitarian crisis in the world is not enough, Yemen’s humanitarian situation continues to worsen now that COVID-19 is posing additional pressure on the health system. Yemen’s already collapsing infrastructure may face complete obliteration if aid is not provided. The lives of 19.7 million people in need of health care will be at risk. Many of these people are vulnerable communities who are either displaced, disadvantaged, suffering from chronic illnesses, malnourished or all the above.
WHO and partners are aware of the severity of needs in the country and are sparing no effort to support the health system from further deterioration to save the lives of people in need of health care.
Currently, WHO and KSrelief are supporting 189 hospitals across the country. That is 75% of the 252 operational hospitals in Yemen. Up to 4.34 million people will have access to health services through this support. This includes the provision of the Minimum Service Package at the primary and secondary level by supplying medicines and medical equipment and fuel.
