Medecins Sans Frontieres health facilities have faced multiple airstrikes forcing an evacuation from six hospitals in Northern Yemen. According to a 2016 update by MSF, Saudi-led military attacks have resulted in at least 200,000 people losing access to quality healthcare.
As a result of the Yemen conflict which began in 2015 between the Houthi rebels and pro-Hadi government forces, Yemen’s health facilities have decreased by 20%, according to the United Nations Office for Coordination of Humanitarian Affairs. In response to the health resource crisis, the Ministry of Health in Yemen have aligned with 20 partner organisations, including the International Committee of Red Cross (ICRC) and Medecins Sans Frontieres (MSF).
Furthermore, the United Nations has reported that the faculties of health centres in Yemen have become “non-functional” due to damages made by airstrikes on hospitals and shortages of resources for civilians. Kyla Ulmer, an MSF external activities manager of the Amran governorate from Perth discusses with Avenoir the health facility situation and the conditions of the Yemeni people in the camps and hospitals of Khamir, Yemen.
What was your position at the camp/hospital? What were your role(s) and responsibilities?
I was the external activities manager, which meant I was responsible for all outreach services. Practically, this meant I was responsible for the management of a small 20 bed hospital, three smaller health centres, and two mobile clinics throughout Amran governorate. I monitored the situation in the outlying areas so we could quickly respond to any issues such as outbreaks of diseases like malaria or acute watery diarrhoea. If I was doing my job well, the burden to the main hospital MSF supports in Khamir city would be reduced because people could be treated closer to home rather than needing to be referred.
Which hospital(s) have you been situated in? Have you worked in other camps? Which was the most challenging and why?
As I mentioned, I mainly worked in one small hospital, plus three smaller health centres, and two mobile clinics. Previously, I worked in a hospital in a refugee camp in South Sudan which was a completely different experience. Each situation is challenging in its own way, I suppose. Yemen was difficult because of the distances between health centres — we had a clear referral system, but patients would still have to travel almost two hours over a bumpy road in order to be transferred from a health centre to the main hospital in Khamir if they were in a serious condition. They may have already had to walk long distances just to reach the remote health centres, so their conditions could deteriorate quickly. Access to health care is a big problem.
How has it been working with Yemeni nurses? Is there a culture clash between the Yemeni and Western nurses/soldiers? Have there been tribal conflicts occurring within the camps/hospitals? Who would be in conflict with one another?
Most of the Yemeni nurses I worked with were very happy to have MSF’s support. Local conflicts are a major problem in the mountains where I worked. Tensions could escalate quickly over minor issues so it was always something to be mindful of.
How has it been difficult in acquiring resources and keeping up with the demands of the displaced families there?
It’s not terribly difficult for us to get the resources we need, in terms of medication and supplies. The issue is that we’re a medical organisation and a lot of the people in Yemen need things like tents, mosquito nets, warm blankets, and household items. We can provide a high level of health care, but the needs are so great it can be hard to keep up.
What if you were to run out of resources? Where would the patients be sent off to?
Luckily MSF is well-resourced thanks to our donors. If we were unable to treat patients they’d be referred to a hospital in Sanaa. Private hospitals in Sanaa tended to be better resourced but were often too expensive for patients. Public hospitals may be out of medication or supplies, which made referral difficult.
What was the most prevalent condition treated within the hospital/camp? Who was the most affected?
The most prevalent condition (excluding outbreaks) is probably always going to be watery diarrhoea. Diarrhoea is the number one killer of children worldwide and is so preventable and treatable. Malnutrition was also quite widespread and we had small outbreaks of malaria and measles. Children are always the most affected because their bodies are so vulnerable and can’t handle the stress that adults can handle.
Has the situation in Yemen worsened and caused more of a displacement for the Yemeni people?
The country has been at war for a couple years now so things are fairly dire politically. There has been an almost complete breakdown of infrastructure – government services no longer function, which is having a devastating effect on the population.
Have you been in a situation where the camp/hospital you were in has gone under siege? Have there been attacks in nearby camps/hospitals that have affected your progress in Khamir?
No – I’ve never been under siege. We had several situations which increased the security risk. During that time I wasn’t able to travel to the outlying areas and had to remain in the office in Khamir.
What other organisations are situated there? How much of a contribution have they made towards helping MSF and the Yemeni people?
Oxfam was doing some work in water and sanitation and UNICEF provided some supplies. I’m not too familiar with the details of what they were doing or if any other NGOs were there.
The World Health Organization are also present with 65 of the staff working with partner organisations distributing medical supplies and treating and maintaining national surveillance in identifying outbreaks.
What policies do you feel need to be made towards the Ministry of Health? What are the concerns you have towards the health system in place there?
As a medical humanitarian aid organisation we’re not really there to tell them what to do – we’re there to help support the country while they’re so vulnerable. The health care system is non-functioning at present because there are no resources. Staff haven’t been paid, hospitals function without any medications…things are quite dire. It’s our job to fill that gap until the system can function on its own again.
Have you had to deal with malaria season? If so, was the condition rampant to where it was difficult to control? How about the malnourishment within the camps/hospitals?
We did have a small malaria outbreak but it was mostly manageable. In previous years the government was able to distribute mosquito nets and spray for mosquitoes to reduce the problem, but this year they didn’t have the funds to do that. Cases started increasing in September and remained high until about November. We did a small mosquito net distribution in two [Internally Displaced People] IDP camps and ran extra mobile clinics in the areas that were most affected. Malnutrition was also an issue, especially in the areas most affected by air strikes. Yemen is largely reliant on imports for food, which the war has drastically decreased.
In a 2016 article by Aljazeera, it was declared by UNICEF warning that about 320,000 children would face life-threatening malnutrition as result of the conflict. In the camps of Khamir, the displaced Yemeni people live in tents with latrines and water sources nearby; a necessity contaminated by the irregular emptying of the septic tanks with rocky grounds difficult to access water or grow crops in, according to Ulmer. The World Health Organization (WHO) reported an outbreak of malaria in 2015 due to the civilians collecting water from containers infested with mosquitoes.
According to a 2015 update by Dr. Berbain from MSF states the population at the camp in Khamir increased from 3 to 85 families. Has the number increased in size since then?
There was one large IDP camp in Khamir and several other IDP camps in the governorate. It was difficult to get an accurate number of residents in the camp, but there were likely fewer than 85 families when I was there. The numbers fluctuate widely – increased air strikes to the north would bring more IDPs and then they would return home when things calmed down. A large number of IDPs also lived in the city itself, taking shelter in abandoned buildings, schools, and with residents. So it’s difficult to get a really accurate number.
“The world has not only turned its back on the people of Yemen; many states have actually contributed to their suffering, supplying the weapons and bombs that have been used to unlawfully kill and injure civilians and destroy homes and infrastructure. This has caused a humanitarian catastrophe,” said Brian Wood, Head of Arms Control and Human Rights at Amnesty International. What’s your view on this? Do you feel the world has turned its back on Yemen?
I think a lot of people have no idea what’s going on in Yemen. Maybe it’s not so much that they’ve turned their backs; they were never aware of the situation in the first place. I think people would be horrified if they knew what was happening there.
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