Yemen: Latest MSF Updates

This information is excerpted from MSF’s 2016 International Activity Report.

Yemen’s full-scale war, raging since March 2015, has inflicted immense costs on the population. Medical services were in a critical state as hundreds of health facilities across the country stopped functioning due to airstrikes, shelling, lack of supplies, or inadequate funding or staff. MSF scaled up its activities, directly providing health care to patients in 12 hospitals and supporting at least 18 other health facilities.

In 2016, more than 32,900 patients in facilities operated or supported by MSF received treatment for intentional physical violence, including war wounds—and nearly half of them were treated by MSF teams. MSF’s program in Yemen was one of its largest worldwide in terms of personnel.

Between October 2015 and August 2016, MSF lost 26 colleagues and patients in four separate bombings of health facilities it ran or supported. Following the airstrike on Abs hospital on August 15 that killed 19 people, including an MSF staff member, MSF temporarily withdrew its staff from six hospitals in the north of Yemen while continuing to support the facilities. MSF ran the emergency room, inpatient department, pediatric ward, and maternity departments at Abs hospital, and opened an inpatient therapeutic feeding center in December. MSF conducted medical outreach activities for people living in and around camps for the internally displaced in Abs district. MSF also provided lifesaving health care in Al Jumhouri hospital in Hajjah town.

In Sa’ada governorate, MSF provided assistance in the emergency room and maternity department of Shihara hospital, which was hit by a missile in January 2016. Haydan health center was hit by an airstrike in October 2015, nevertheless MSF continued to work there until August 2016. MSF teams worked in the maternity, surgical, and inpatient departments, and provided mental health care and physiotherapy in Al Jumhouri hospital in Sa’ada.

In Amran governorate, MSF helped provide health care and ran referral systems in Al-Salam hospital and four health centers. In May, MSF conducted a scabies treatment campaign at camps for internally displaced people.

MSF supported the emergency room and operating theater in Al-Kuwait hospital in Sana'a and donated emergency supplies to Al Jumhouri, Al-Thawra and Al-Sabeen hospitals.

MSF continued to support the Ministry of Health's HIV program, helping to ensure that, despite the violence, 97 per cent of the program’s 2,529 patients received their lifesaving antiretroviral treatment.

In Ibb governorate, the most densely populated region of Yemen, MSF supported the emergency department of Al-Thawra Hospital. MSF rehabilitated the General Rural Hospital of Thi As-Sufal district, close to the front lines, and performed lifesaving surgeries on severe medical cases.

​The situation was critical in Taiz as most hospitals were forced to close amid heavy fighting. Movement in and out of the city was restricted and dangerous for civilians and humanitarian workers. MSF provided lifesaving medical activities on both sides of the front line, treating patients with injuries resulting from airstrikes, blasts, shelling, gunshots and landmines. Teams continued to run a mother and child hospital and a trauma center, and regularly supported four other hospitals in the city.

In Ad Dhale, where fighting flared in August, MSF worked in Al-Nasr Hospital, Al Salam hospital, Thee Ijlal health center, and Damt health center.

MSF continued to run its emergency surgical hospital in Aden, providing lifesaving health care to thousands of people. MSF medical staff also provided primary health care services to inmates at Aden central prison.

UPDATE: July 4, 2017

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UPDATE: July 2, 2017

The number of suspected cholera cases reported by World Health Organization (WHO) and Yemen’s health authorities has reached 252,816, with 1,560 reported deaths. The epidemic that began on March 30 now includes cases reported from 19 of Yemen’s 22 governorates. The scope of this outbreak is significantly wider than the one that occurred immediately prior, between October 2016 and March 21, 2017, which saw 23,506 cases across 15 governorates, according to the WHO.

Poor sanitation and a lack of safe drinking water, both caused by the ongoing conflict, are increasing people’s susceptibility to cholera. Those also suffering from malnutrition are particularly vulnerable to cholera. As the outbreak spreads to more remote communities with even fewer services, people are increasing unable to access health facilities in time for treatment.

The overall collapse of Yemen’s health system is the key underlying cause of the spike in cases over the last weeks, as cholera treatment units managed by the Ministry of Health have been unable to deal with the high numbers of cases.

MSF Response

MSF has witnessed a sharp increase in suspected cholera patients at its facilities in Yemen. Between March 30 and May 30, MSF had treated 12,181 patients. By June 4, that number had nearly doubled to 24,135, and by July 2, the number of patients had more than doubled again to 60,631 suspected cholera patients treated since the outbreak began.

MSF is operating nine cholera treatment centers (CTCs), seven cholera treatment units (CTUs), and two stabilization units across nine governorates (Amran, Hajja, Al-Dhale, Hodaidah, Ibb, Taiz, Sana’a, Aden and Abyan) and continues to adjust its services as needed by opening new centers, supporting other facilities through donations of supplies and training, and continuously evaluating the needs.

MSF Cholera & Acute Watery Diarrhea Figures

MSF has treated 60,631 patients (cholera cases & acute watery diarrhea):

16,341 patients in Hajja Governorate (between March 30 and July 1)

10,042 patients in Ibb Governorate (between May 3 and June 30)

7,942 patients in Amran Governorate (between April 25 and June 30)

7,276 patients in Al-Dhale Governorate (between April 23 and July 2)

5,727 patients in Aden Governorate (between April 10 and July 1)

3,827 patients in Hodaidah Governorate (between May 19 and June 26)

4,139 patients in Taiz Governorate (between May 7 and July 2)

4,283 patients in Sana’a Governorate (between May 23 and July 2)

1,054 patients in Abyan Governorate received (between May 12 and July 1)

MSF Cholera Treatment Facilities Locations

Amran Governorate

99-bed CTC at a public school in Khamer

25-bed CTU at Huth Hospital

10-bed cholera stabilization unit at Al-Qafla

10-bed cholera stabilization unit Harf Sufyan

Hygiene kits are being provided to patients admitted to our facilities and to area households. Contents include one month’s supply of handwashing soap and water purification tablets, as well as four sachets of oral rehydration salts,  a five-gallon jerry can to store treated drinking water, and detergent powder for jerry can cleaning. Health education is also being provided to patients and caregivers in the Khamer CTC.

As there is a huge need for improved hygiene and sanitation in the valley area, MSF will complete  distribution of 3,000 hygiene kits by mid-July.

MSF is also implementing a comprehensive outreach strategy targeting the most affected areas to stop the chain of transmission. This includes setting up 15 oral rehydration points (ORPs) in the most affected districts of Khamer, Huth, Al Qaflah, Harf Sufian, and the Osman Valley, and training community members to run them.  

Hajjah Governorate

125-bed CTC at a public school near Abs Rural Hospital in Abs town

100-bed CTC at a public school near Al-Jomhouri Hospital in Hajjah city

MSF's CTCs in Hajjah Governorate have treated hundreds of patients each day in recent weeks. Many people have traveled up to five hours to seek treatment. As of July 1, the Hajjah CTC had treated 4,727 patients, and the Abs CTC had treated 11,614.

MSF has set up nine CTUs across the governorate and is providing direct support to other local medical structures in the region through trainings, donations of supplies, supervision, a referral system, and incentives to public health workers in the most affected rural areas. The plan also includes the establishment of at least five oral rehydration corners to reduce pressure on the CTCs.

Apart from the treatment of patients, MSF’s main priority in Hajjah is outreach activities to help contain the epidemic. MSF is focusing on hygiene promotion in hard-to-reach areas and the chlorination of wells. Teams are also communicating awareness-raising messages to the local communities through community health workers and radios, and in collaboration with imams at mosques. In addition, MSF is providing hygiene and disinfection kits with clear home-use instructions to patients who come to our CTCs and their families.

Al-Dhale Governorate

20-bed CTU at Al-Salam Hospital, Qatabah

16-bed CTU at Al-Nasr Hospital, Addhale

14-bed CTU at Damt Health Center

10-bed CTU at Al-Azareq

Hodaidah Governorate

20-bed CTU at Al-Olfy Hospital

Taiz Governorate

30-bed CTC at a school in Al-Houban

4-bed CTU at MSF’s Mother & Child Hospital

Ibb Governorate

100-bed CTC in Ibb city

80-bed CTC at Thi As Sufal General Rural Hospital

Sana’a Governorate

55-bed CTC at Al-Kuwait Hospital

MSF has been donating drugs for cholera management to three hospitals in the governorate, the 22nd of May Hospital, Al-Jomhouri Hospital, and Azal Medical Compound.

Aden Governorate

100-bed CTC in a new building that was made available by the Ministry of Health (MoH)  at the Al-Sadaqa Hospital compound.

The capacity of the Al-Sadaqa CTC is still not adequate, as more than 150 patients arrive every day. Some patients have been admitted on mattresses placed on the ground. MSF is supporting the MoH in efforts to open more referral centers in Aden to ease the case load.

Abyan Governorate

35-bed CTC in a dedicated zone of the MoH hospital in Lawdar.

In both Aden and Abyan, MSF is providing support by offering donations of supplies and infection control training to staff.

CURRENT ACTIVITIES

MSF currently works in 13 hospitals and health centers in Yemen and provides support to more than 18 hospitals or health centers across 11 Yemeni governorates: Taiz, Aden, Al-Dhale’, Saada, Amran, Hajjah, Ibb, Sana’a, Hodaida, Abyan, and Lahj. With nearly 1,600 staff, including 82 international staff, Yemen is among MSF´s largest missions in the world in terms of personnel. MSF operations in Yemen had a budget of more than 110 million Euros for 2015 and 2016.

MSF Projects

Saada

MSF resumed its presence in Haydan Hospital in February 2017 with an international team, running the emergency room (ER), maternity ward, and the inpatient department. MSF also provides assistance in the emergency room and in the maternity department of Shiara Hospital, which was hit by a rocket in January 2016. MSF also supports health structures in Yasmim and Noshour.

Hajjah

In Abs Hospital, MSF runs the ER, the pediatric ward, the maternity ward, and the emergency surgery with post-operative care, including mental health support for both patients and caretakers. In addition, MSF opened an inpatient therapeutic feeding center (ITFC) within the hospital in early December 2016.

Yemen: Saudi-Led Airstrike on Abs Hospital Cannot be Justified as Unintentional Error

Through a system of mobile clinics, MSF teams provide basic medical care to people in Abs District while monitoring the epidemiological and nutritional situation. MSF also provides mental health services through outreach activities for the population in and around camps for internally displaced people.

In Hajjah City, MSF has supported the main public referral hospital in the governorate in the ER, with surgical services, in the intensive care unit, and in post-operation wards since August 2015, and with maternity services since July 2016.

Amran

MSF runs the emergency room, inpatient department, ITFC, operating theater and the maternity unit in Al-Salam Hospital and supports health centers in Al-Qafla, Huth, and Harf Sufyan through health care provision; donations of medications, oxygen, logistical equipment, electricity, and human resources; and a referral system. MSF provides medical supplies, trains personnel in emergency care, repairs and improves damaged structures, and runs ambulance and reference systems in a number of health structures in Amran Governorate.

Sana’a

MSF continues to support the emergency room in Al-Kuwait Hospital in Sana’a. Additionally, MSF donates emergency supplies to Al-Jumhouri and Al-Thawra hospitals and provides war-wounded care kits in the districts surrounding Sana’a, including Arhab, Nihm, Hamdan, and Jihanah. MSF also supports the Al Sabeen Mother and Child Hospital in Sana’a.

MSF’s support to the Ministry of Health’s HIV program in Sana’a continues. More than 1,750 patients from the capital and several governorates received lifesaving antiretroviral treatment in 2016. In addition, MSF supports voluntary counseling and testing as well as prevention of mother-to-child transmission sites in parallel to its advocacy work for the rights of people living with HIV to fight the stigma and discrimination against them in health facilities. MSF has provided regular blood testing kits to the National Blood Bank in Sana’a since September 2015.

Ibb

Due to MSF’s inability to run activities according to its principles of independence and impartiality, MSF withdrew from Al-Thawra Hospital in Ibb on April 20, 2017.  MSF will continue to support the hospital for the next two months with donations and incentives. MSF provided lifesaving care in the emergency room of the hospital, treating over 41,000 patients—half of them in critical condition—in 2016, and reinforced the hospital’s capacity to manage mass influxes of trauma patients. MSF has obtained permission to independently assess other medical needs in Ibb Governorate to launch a new project.

MSF still works in the General Rural Hospital of Thi As Sufal District. The hospital is the closest to one of the country’s violent front lines bordering Taiz Governorate. MSF directly provides emergency medical care, lifesaving surgeries, and inpatient hospitalization for the most severe medical conditions. MSF also ensures mass casualty management capacity of the hospital.  On average, MSF teams offer 250 consultations in the emergency room and perform 80 surgeries per week. Finally, MSF provides regular monthly donations to the maternity department, in addition to water, fuel, and other support to the entire hospital.

Taiz

MSF runs lifesaving medical activities on both sides of the front lines in Taiz, Yemen’s third-largest city, where most hospitals have closed due to the conflict. In Al Houban neighborhood, MFS runs a mother and child hospital, where 458 deliveries were recorded in March and over 2,500 severely malnourished children were admitted to the therapeutic feeding clinics supported by MSF in Taiz.

MSF runs a trauma center for war-wound and trauma cases and covers referrals. In the enclaved city center, MSF supports Al-Jomhouri Hospital with maternity services, Yemeni Swedish Hospital for pediatrics, Al Thawra Hospital with medical and surgical emergency rooms, and Al Rawdah Hospital’s emergency room for war-wounds. Most of the wounded come from the city center, where many civilians are caught in the middle of intense fighting, struggling for food and survival. The patients MSF sees in Taiz mainly suffer from injuries caused by airstrikes, blasts, shellings, gunshots, and, most recently, from landmines. Movement in and out of the city remains restricted and dangerous for civilians and humanitarian actors. MSF also provides medications to the emergency room and emergency operating theater supplies to Khalifa Hospital in Al-Turba in Taiz.

Al-Dhale’

Al Dhale’ Governorate is located on the old border between northern and southern Yemen and, besides being affected by the current conflict, it is also affected by ongoing tensions over the old border. The governorate has front lines on three sides between pro-Hadi forces and pro-Houthi forces (Hamak, Taiz, and Moreis/Damt). Shelling along the front lines hit civilian houses and cars. MSF works in partnership with the hospital in Al Dhale’ and district health centers in Al Azariq and Qatabah, running emergency room services, outpatient consultations, surgeries, inpatient services, patient referrals, pediatrics, nutrition programs, and maternity services. The emergency room of the health center in Damt was supported after an increase in war-wounded patients in the area.

Aden

MSF runs an emergency surgical hospital in Sheikh Othman District, in the north of the city. The hospital provides free medical care in an emergency room, a hospitalization ward, and an operating theater, and provides mental health and physiotherapy consultations. MSF is still seeing victims of landmines and unexploded ordinance coming from Aden, Taiz, Lahj, and Al-Dhale’.

A medical doctor and nurse conduct weekly visits to Aden Central Prison to provide primary health care services. An average of 50 consultations are provided every week.  MSF provides incentives for technicians at the prosthetic  center and supports the national blood bank with tests, special blood bags, and reagents for the machines.

The Aden project supports several health centers and hospitals in the adjacent governorates as follows:

  • Atturbah Hospital in Taiz
    MSF supports the hospital with medications for surgical activities and the emergency room and incentives for some of the staff in the emergency room, in addition to providing logistical and biomedical equipment maintenance.
  • MoH Advanced Medical Post in Dhubab District, Taiz
    MSF supports the emergency room.
  • MoH Health Center in Mocka, Taiz
    MSF supports the hospital.
  • MoH Hospital in Lawdar, Abyan
    MSF supports the hospital with medications for surgical activities and the emergency room as well as incentives for emergency room and operating theater staff, along with transportation of patients to Aden by ambulance.
  • MoH Hospital in Jaar, Abyan
    MSF supports the hospital with medications for anesthesia and supports the operating theater.
  • MoH Hospital in Ataq, Shabwa Governorate
    MSF supports surgical and emergency activities.
  • MSF Clinic in Karesh, Lahj Governorate
    MSF runs this clinic inside an MoH compound to stabilize wounded and trauma cases and transport patients to the MSF hospital in Aden. MSF also provides incentives for the MoH staff working in the clinic.
  • MoH Health Center in Naaman, Lahj Governorate
    MSF supports and trains the staff in the health center to restart services and provide medications.
  • Two MoH Clinics in Denaem/Zaher District in Al-Baida Governorate
    MSF supports these health centers with dressing materials, stabilization kits for trauma, and basic medicines.

Hodaida

MSF supports the emergency room in the MoH-run Al-Olfy Hospital in Hodaida with medications and medical supplies and provides incentives for 60 staff members.

Other Activities

Dialysis

Since October 2015, MSF has been supporting dialysis treatment centers in Sana'a, Saada, and Hajja. MSF also began supporting two dialysis centers in Taiz and Mahweet in August 2016, bringing in 240 tons of medical supplies for this activity alone. MSF is looking into the possibility of supporting three new centers.

Mental Health

MSF has progressively increased its mental health and psychosocial support activities across the country. The teams are composed of clinical psychologists and counselor-educators who target a population that includes victims of violence and their families with special attention to war-wounded, internally displaced persons, and children.

In 2016 MSF provided 5,700 individual and family sessions to over 2,700 beneficiaries and their relatives, in addition to group interventions to educate local communities about mental health, reduce stigmatization, and teach basic techniques for psychological hygiene and to restore previous coping mechanisms. Recreational activities for hospitalized children were part of this package. These activities continue.

Furthermore, MSF provides regular trainings to medical staff in the MSF-run or supported hospitals in different regions to improve the referral system and understanding of the psychological effects of exposure to violence. Mental health teams are also actively involved in mass casualty contingency planning and implementation.

MSF Health Facilities Hit by Airstrikes/Missiles
Date Facility Governorate Casualties
August 15, 2016 Abs Hospital Hajjah 19 killed, 24 wounded
January 10, 2016 Shiara Hospital Saada 6 killed, 7 wounded
December 2, 2015 Al-Hoban Clinic Taiz 1 killed, 8 wounded
October 26, 2015 Haydan Hospital Saada 1 wounded

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