Lack of funding cripples Yemen’s health system | International

Nema Báker remains very still on the stretcher. This Yemeni mother is a regular at the Al Jumhuriya hospital hemodialysis center in Aden. She has been coming twice a week from Radfan, a village in neighboring Dhalea province, for treatment for several years now. “I have only missed when there was fighting,” she says. Now the city is apparently calm, but the effects of a war that has entered its eighth year have put the last straw in Yemen’s weak health system. With no electricity, no clean water, and no funds, hospitals struggle to care for the sick and injured. International aid is her only hope.

Baker, 50, explains that dialysis requires added medication like calcium and vitamins. “Before, the hospital provided it to us; now we have to pay it and with inflation it has gone from 30,000 to 50,000 riyals a month [de 30 a 50 euros]”, bill. It is a fortune in a country where 80% of the population survives on less than three euros a day. Still, she and the other patients in her neighborhood who occupy any of the 28 available beds are lucky because a benefactor pays for the minibus to take them to the hospital, a grueling three-hour journey each way.

Nabiha Bamagid, the head of the department, warns of the seriousness of the situation. “We are seeing younger and younger patients who die because they cannot pay for complementary medicines to dialysis, including some cases of children under five years old,” he told a small group of journalists during a recent visit to Aden with the study center Sana’a Center. To the insufficient capacity of the unit (overwhelmed because the neighboring provinces lack this service), has been added the lack of supplies since the outbreak of the war between the Huthi rebels and the internationally recognized government.

“Our situation was complicated by covid, since it has affected people with kidney diseases, aggravating their condition. We have had to improvise a specific isolation area, but we can’t cope,” Bamagid confides in the middle of a shift that started at five in the morning. “Without the support of the International Committee of the Red Cross (ICRC) we could not continue operating,” he points out before adding that the King Salman Foundation (of Saudi Arabia) provides them with fuel for the generator.

The hospital’s chief executive, Ahmed Salem al Shabahi, says the problems are not new. “The war worsened seven years ago, but it started 30 years ago,” he says, referring to the confrontation between southern and northern Yemen in 1994, just four years after the country’s unification. Since then, southern Yemenis have complained of marginalization in public investments and abandonment by Sanaa, the country’s capital, in the hands of the Houthi rebels since late 2014.

Be that as it may, today public health is in a dilapidated state throughout the country. According to the World Bank, at the end of last year barely half of the health centers were working and 80% of the population had difficulties accessing them. The lack of human resources, equipment and supplies have deteriorated the services. As a result, deaths in childbirth and newborns have increased, as have cases of child malnutrition, fewer children are vaccinated, and outbreaks of contagious diseases such as measles are resurfacing in some areas. All this, in the midst of the pandemic and in a context of declining foreign financing.

This year the UN has barely obtained a third of the 4,300 million dollars (4,079 million euros) it was seeking to serve the most vulnerable population. Donors fear that the aid will fall into the hands of the different groups in contention. In 2019 alone, the Houthis appropriated some $1.8 billion in humanitarian assistance intended for civilians. The two-month ceasefire between the government and the rebels that the UN announced in early April has opened a window of hope.

“It is difficult to speak in a general way because the situation is very heterogeneous. It is not the same on the war fronts, like in Hajjah, where there is bombing and malnutrition, than in a province like Amran, where there is little violence and diseases are more linked to poverty”, explained an international aid worker from the sector before the truce.

Humanitarian organizations also face different problems in the north and in the south of the country. While in the territory controlled by the Huthi they complain of difficulties of access and limitations on movement, in the south there is concern about the insecurity derived from the proliferation of militias and kidnappings. The recognized government, based in Aden, does not pay the salaries of health personnel in the north, who are totally dependent on humanitarian aid. In the south, salaries arrive irregularly.

At Al Jumhuriya, Aden’s referral hospital with 450 beds, doctors barely earn the equivalent of 100 euros a month; nurses, less than half. This is a decreasing figure due to inflation. The discouragement of the staff pales next to the state of the facilities. Hallways and rooms are filthy. There is no air conditioning, not even fans despite the sticky humidity. The sheets haven’t been changed for days. In the accesses to the surgery area the light bulbs are burned out.

The director complains about the lack of help. “During the covid pandemic, the international community has discriminated against us,” he says before acknowledging that the facilities opened by the Southern Transitional Council (the separatist group that controls Aden) had the support of the World Health Organization and the ICRC. He admits that even after the recent agreement between the power de facto and the Government, the situation of the hospital is very difficult.

Al Shasbahi, a convinced separatist and anti-colonialist, would like the center to recover the splendor it had during the British mandate. “We still have the same facilities as when it opened in 1954 ″, he points out the old photograph that presides over his office, in which Princess Alexandra (a cousin of Queen Elizabeth II) is seen visiting the hospital. “We need help from the international community, for donors to take action,” he claims, helpless in the face of the political paralysis in his country.

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