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Leukaemia patients in Yemen suffer in silence amid war
Dr Abdulrahman Al-Hadi faces a sad reality daily, one that reflects the overall situation in Yemen. “Some patients die because life-saving medications are unavailable at the Centre. Some medications cost US$ 100 or more and people don’t have even a fraction of that amount” (Photo: WHO/Sadeq Al-Wesabi).20 November 2018 – Millions are living through the worst humanitarian crises in the world. In a world where basic infrastructure and services are a presumed part of daily life, Yemeni citizens struggle to meet simple needs of access to clean water, sanitation, food and primary health care. The energy formerly spent on development and capacity-building is being wasted on struggling to stay alive and healthy.
Almost four years of war has pushed an already weak health system to near ruin. People with chronic illnesses are struggling more than ever before to access treatment. The current situation forces 35 000 cancer patients – and nearly 11 000 new cases are diagnosed yearly – to hope only to survive rather than thrive. Almost half of the hospitals and health facilities have been destroyed due to the war, leaving the health system teetering on the brink of collapse.
The Leukaemia Centre in Sana’a is the only specialized leukaemia treatment centre for children in Yemen. With zero government support the Centre is in dire need of supplies and what is available covers only a fraction of the needs of incoming patients.
Tamir Abdulqader from Al Hudaydah governorate is seven years old and is one of three siblings. Pain in his joints three months ago prompted his mother to seek medical advice; unfortunately, he was misdiagnosed until he came to the Leukaemia Centre in Sana’a where he is currently receiving proper treatment. Tamir’s mother who accompanies him does not have anyone to support her, including her husband. “Once he learned about Tamir’s diagnosis, he told me that he is dead to him. We are divorced now and I don’t have anyone to help me” she says. Not only is she in debt after being forced to move to Sana’a for treatment, her two other children have been left with their grandmother in Al Hudaydah, who has been forced to sell her belongings just to make ends meet.
Poverty, vulnerability, and lack of supplies
Being the only specialized centre in Yemen, there is a great deal of pressure placed on the Leukaemia Centre that it is not equipped to take on. The sheer number of patients coming in from all governorates exceeds the available capacity and medical supplies. “Many patients coming in can’t afford to buy even the basic supplies such as an IV or cough medicine” says Dr Abdulrahman Al Hady, Director of the centre in Sana’a.
The Leukaemia Centre continues to receive patients from all over the country in significantly rising numbers, while severely lacking supplies and medication. (Photo: WHO/Sadeq Al-Wesabi).
Shaima, seven, sits in the other room with her mother who accompanies her. In a pink headscarf, her tired little face seems even smaller, though her eyes still shine with the light of hope. She was diagnosed with leukaemia a few months ago after being in a car accident that injured her foot. “She was very scared and had a persistent fever for a few days after the accident. Her joints started to hurt her and that’s when I took her to the hospital,” says Shaima’s mother.
She tried two hospitals that rejected her admission before being admitted into the Leukaemia Centre. “We don’t have a place to stay, so we move around and stay with relatives whenever we can.”
With 22.2 million requiring humanitarian assistance, those with chronic diseases fall through the cracks
Shaima was diagnosed with leukaemia a few months ago after being in a car accident that injured her foot. Her family tried two hospitals that rejected her admission before being admitted into the Centre. (Photo: WHO/Sadeq Al-Wesabi).Many families of patients suffering from chronic diseases face devastating circumstances and struggles in their plight to access medical care. Poverty, lack of resources and medical care is common to millions of Yemeni people. About 75% – some 22.2 million people – require humanitarian or protection assistance, and more than half of them (11.3 million) require acute assistance, an increase of 1 million since July 2017.
The Leukaemia Centre continues to receive patients from all over the country in significantly rising numbers, while severely lacking supplies and medication. Only 20% or less of their needs are covered, and the death rate is higher than ever. “Sometimes incoming patients can’t afford to purchase the supplies that are not covered by the Centre, and out of compassion, doctors purchase these supplies themselves to assist those patients” Dr Abdulrahman adds. With the exchange rate of the US dollar increasing dramatically, prices of medication have sky-rocketed, tripling in price while most of the population struggle to put food on the table.
Many families of patients suffering from chronic diseases, like Hussein, face devastating circumstances and struggles in their plight to access medical care (Photo: WHO/Sadeq Al-Wesabi).Hashed is six years old and has been sick for five months now. He sits on the hospital bed and his eyes are fixed on a very small TV screen on the wall playing children’s songs, his energy drained by his disease. His mother had to move to Sana’a from Ibb governorate with her thee children to seek treatment for Hashed. “He started experiencing pain in his legs. They became stiff which prevented him from walking,” says Hashed’s mother. After Hashed’s diagnosis they were advised to travel abroad for treatment that wasn’t available in the country, but they couldn’t afford the expense.
“We can hardly afford the medication prescribed here. We have to buy the cheaper brands because the good ones are very expensive,” she adds.
Dr Abdulrahman faces a sad reality daily, one that reflects the overall situation in Yemen. “Some patients die because life-saving medications are unavailable at the Centre. Some medications cost US$ 100 or more and people don’t have even a fraction of that amount.”
To add to this dire situation, health workers continue to work tirelessly for hours on end without a salary, thereby unable to provide for their own families.
WHO continues to support the National Oncology Centre in Sana’a and its branches in all governorates with various essential and life-saving anti-cancer medicines and chemotherapy medication. This medication is sufficient to cover the acute shortages of medicines for more than 30 000 cancer patients for one year — but this is not enough. More needs to be done or many more people will die from preventable and treatable diseases.
WHO supports district health facilities in Yemen to respond to basic health needs
It takes Taqiya Ali, 70, 3 hours from her home town of Al Saudah to Azal Health Centre in Sana’a, where she was diagnosed with cholera. During the drive, she experienced severe diarrhoea and vomiting, causing her to faint many times (Photo: WHO/ Hanan Ishaq)7 November 2018 – More than 3 and a half years of war and conflict in Yemen have resulted in widespread devastation and the silent suffering of millions of people. With half of all health facilities closed, access to basic services is limited for Yemenis, resulting in an extremely deteriorated health situation across the country.
Vulnerable communities are forced to travel long distances in order to access basic health care. Due to the precarious economic situation as a result of the conflict, the sick have no choice but to stay at home and face the risk of dying, simply because they cannot afford to pay for transportation to the nearest functional health facility.
Azal Health Centre in Azal District, Sana’a, is supported by WHO through the provision of essential medicines and medical supplies and supporting health workers with financial incentives. The centre is overcrowded with cholera patients of different ages, many of whom have had to travel for hours to reach this facility.
Internally displaced persons from Hudaydah endure harsh circumstances in Sana'a
Dissipated sense of security
With the recent escalation of conflict in the port town of Al-Hudaydah, thousands of people were forced to flee to the capital city Sana’a to escape the insecurity and increasing poverty, malnutrition and disease outbreaks. These displaced people include Yemen’s most vulnerable: the elderly, pregnant women, people who carry the burden of chronic illnesses, and caregivers who bear the responsibility of providing for their children.
Abu Bakr school in Sana’a serves as a transit facility for many displaced families from Al-Hudaydah who have nowhere else to go. Through its partnership with the World Bank under the Emergency Health and Nutrition Project (EHNP), WHO has provided the transit facility with emergency medicines and health supplies for 1000 medical consultations. Support from the Office of US Foreign Disaster Assistance (OFDA) also enabled WHO to provide medicines for 200 patients suffering from hypertension, diabetes and psychosis.
Weighed down by harsh circumstances and forced displacement
Being from Al-Hudaydah, many displaced families are not used to the colder weather in Sana’a and have not yet acclimated to it. Their living space is crowded, with several families often living together in one classroom. Their main concern is the safety and well-being of the children.
Many of the displaced families are headed by women, some of whom are weighed down by old age, chronic illnesses, children to care for, and empty stomachs to feed. Many are sitting on the ground in the schoolyard. They look tired. They have been all been faced with unique circumstances during their displacement, but they all have one thing in common: uncertainty of the future.
There are children playing in the schoolyard, oblivious to the fact that they are far from home. They run around giggling and playing as children usually do. They look joyful, but beneath the surface lingers untold trauma. Memories still seared in their minds, and the perplexing reality they are now forced to live. No child is supposed to face violence of such magnitude at such a tender age, yet displaced children in Yemen experience this daily.
Sama finally got a classroom to rest and take her medication. She has a brain tumor and needs proper medical care she can’t afford. Her medication is provided by charitable donors
Sama has been in Abu Bakr school since last June. She had to sleep on the floor before being assigned a classroom. She lays on a thin mattress with a welcoming smile on her face. Her sister and mother are the only family she has got and they have no support. “We ran away with nothing but our purses and the clothes on our backs” Sama’a sister says. Sama needs all the quiet she can get because she suffers from a brain tumour. “She keeps losing consciousness, if not for the help of charitable donors, she wouldn’t be able to get her daily dose of medicine” adds Sama’s mother.
Nada is a mother of four and was displaced from Al Mina district in Al-Hudayah. She took an overcrowded bus to Sana’a. Upon her arrival, she had nowhere to go. Prior to the conflict, Nada had nothing and was hardly able to provide the day to day necessities for her family. “We heard the sounds of aircrafts and missiles hitting the city, and the battle tanks were already in the neighborhoods. I was terrified for my family and I had to leave,” says Nada while describing the situation after the armed conflict had gripped the city.
Nada’s daughter is sick and lays on this mattress which she shares with her 3 brothers and sisters and mother. They have to sleep in the school corridor until they get a classroom
“Hospitals and pharmacies were closed; people didn’t know where to go. It was a ghost town. All you could hear was the shelling,” She added. Nada does not have a room, so she sits on one of the school corridors where her 2-year-old lies sick on a mattress they all share. “I don’t know what she is sick with, and I can’t afford medical care.”
“We have nothing; we are not part of this. Yet we bear the burdens of this war”
Ahmed fled his home when shelling started in his neighbourhood in Al-Hali district. His fear for the safety of his family of eight forced him to leave everything behind and flee to Sana’a. Khaled arrived in Sana’a with no place to stay. Him and his family were led to AbuBakr school for shelter.
Ahmed fled his home during the shelling in Al Hudaydah in fear for his family’s safety. Arriving in Sana’a, he had no one and didn’t know where to go
Murad came with his family and two extended families. “I don’t know how many we are. There are a lot of us.”
In her heavy winter clothes, the youngest in the family – a two month old- is coughing and has a cold. As the weather in the northern city of Sana’a is something they are not used to, the entire family was wearing winter clothes. There is a lot of readjusting for these families to do, and the uncertainty of their situation continues to increase their vulnerability.
Yemeni health system crumbles as millions risk malnutrition and diseases
Al-Olofi Hospital in Al-Hudaydah23 February 2017, Al-Hudaydah, Yemen - “Hospital staff have not received their salaries for the past 5 months. There are acute shortages of certain medicines and we need more fuel to ensure the hospital has electricity,” says Dr Khaled Suhail, Director of Al-Tharwa Hospital in Yemen’s third largest city, Al-Hudaydah.
With more than 1200 employees and 320 beds, Al-Thawra Hospital is the main functioning health facility in Al-Hudaydah and neighbouring governorates.
Every day, around 1500 people seek care at the hospital, a 5-fold increase since 2012 due to the influx of people displaced by ongoing conflict and the closure of other health facilities in the area.
Last week alone, several thousand displaced men, women and children arrived in Al-Hudaydah Governorate, overwhelming already weakened health facilities and overburdening vulnerable host communities.
The Al-Hudaydah port, one of the main entry points to the country, is functioning at minimal capacity, significantly increasing the prices of goods, including medicines, and reducing economic activity in the city. As a result, many patients are unable to pay the minimal fees for hospital services.
Despite this, no one is turned away from Al-Thawra Hospital and hospital staff provide care to everyone, regardless of whether they can afford to pay. Recently, however, the hospital had to stop providing food for inpatients due to lack of funds.
“The World Health Organization (WHO) assists us by providing fuel and medicines for emergency interventions, and supporting the hospital’s therapeutic feeding centre.” explains Dr Suhail. “However, with no funds for operational costs, we never know if we will still be open one month from now.”
Collapsing health system in Yemen
Since the escalation of the conflict in March 2015, health facilities across Yemen have reported more than 7600 deaths and close to 42 000 people injured. The country’s health system has been another victim of the conflict.
The budget allocated to health authorities has been drastically reduced, leaving health facilities without funds for operational costs and health care workers without regular salaries since September 2016.
“With more than 14.8 million people lacking access to basic health care, the current lack of funds means the situation will get much worse,” says Dr Nevio Zagaria, WHO Acting Representative in Yemen.
Only 45% of health facilities in Yemen are fully functional and accessible, 38% are partially functional and 17% are non-functional. At least 274 of those facilities have been damaged or destroyed during the current conflict. Highly specialized medical staff, such as intensive care unit doctors, psychiatrists and foreign nurses have left the country.
Nutrition crisis
3-month-old Zahraa at therapeutic feeding centre in Al-Thawra Hospital in Al-HudaydahAlmost 4.5 million people in Yemen, including 2 million children, require services to treat or prevent malnutrition, representing a 150% increase since late 2014. Of special concern are almost 462 000 children suffering from severe acute malnutrition and at risk of life-threatening complications such as respiratory infections or organ failure.
“Last year more than 100 children died from severe malnutrition in our therapeutic feeding centre” says Dr Suhail. “The majority of children who come here are from Al-Hudaydah city itself. Those from outside the city can’t afford the cost of transport, so many children simply die at home.”
WHO has established 15 therapeutic feeding centres in 7 governorates, and plans to open an additional 25 centres as the numbers of malnourished children increases across the country.
Urgent funding needs
“We are asked to fill gaps created by the collapsing health institutions,” says Dr Zagaria, “but last year, WHO received less than half of the US$ 124 million required.”
This year United Nations agencies and nongovernmental organizations working to support health care in Yemen are appealing for US$ 322 million, of which WHO is requesting US$ 126 million.
“We urgently need resources to help support the health system as a whole, and are calling on donors to scale-up their support before more innocent lives are lost unnecessarily,” says Dr Zagaria.
