The cholera outbreak in Yemen is escalating at an alarming rate, with experts warning that a child is now infected with the disease every 35 seconds, according to Save the Children.
Grant Pritchard, the charity’s director in Yemen, warned the country is on “the verge of total collapse” as a combination of near-famine conditions and crippled infrastructure fuel the spread of cholera.
Over the past two weeks, the rate of infection has more than tripled, according to Save the Children. It reports that young people are increasingly the worst affected – under 15s now account for nearly half of all cases, compared with 40% last week.
As of the 13 June, 129,185 suspected cholera/acute watery diarrhoea cases and 942 deaths have been registered in 20 of Yemen’s 22 governorates. Unicef estimates that there could be 250,000 cases in six months’ time.
Dr Meritxell Relaño, the Unicef Yemen representative, said the epidemic has come on top of a crisis in public services, which has crippled health, water and sanitation systems. “Cholera came at a moment where the system was about to collapse, where poverty was increasing, where malnutrition peaked. You can imagine what diarrhoea can do to a child who is already very weak, whose immune system is at a minimum – children who are six months old and are only 2.5kg,” she said.
More than 2 million children under the age of five in Yemen are acutely malnourished. Damage to infrastructure caused by two years of intense conflict means 14.5 million people, including nearly 8 million children, do not have access to clean water and sanitation.
The situation is especially bad for communities living in remote areas, where families cannot afford to travel to a hospital. Relaño said Unicef is sending mobile teams to communities in rural areas, but that many families are unable to access a doctor. “Poverty now is widespread,” she said. “Families have used all the money they have in the last two years of the crisis.”
Those who are able to travel to a health centre find facilities that are overcrowded and lacking in basic resources. Medical supplies are flowing into the country at a third of the rate that they were entering Yemen before March 2015.
Saleh, 53, is one of many parents who has struggled to take his sick children to hospital. “At first I took my children to a hospital in Abs [Hajjah province], where they were given some pills and liquids,” he said. “We weren’t allowed inside because the hospital was full of sick people. So, we took a taxi to a hospital in Sana’a, more than 200km away. The most difficult thing has been the transportation. I had to pay $58 [£45] to get a ride from my village to Abs. And then another $78 just to get to Sana’a.”
Dr Mariam Aldogani, a health adviser with Save the Children, speaking from Al-Salakhana hospital in the Red Sea port city of Hodeidah, said health workers are completely overwhelmed. “We have had 1,702 cases from mid-May till now. This is only for Al-Salakhana hospital. The need is high but the resources [are] very limited. You cannot imagine the fear in the eyes of the mothers because most of the cases are children. In some cases there are three [children] in a bed,” she said.
Only half of health centres in Yemen are fully functional, while health workers, like many others in the public sector, have not been paid for almost nine months. “Many of the doctors and nurses have left the country because they were not receiving a salary or because they want to look for other opportunities, given the escalation of the conflict,” added Relaño.
Restrictions on bringing aid and medical supplies into Yemen, including long delays accessing the main Hodeidah port and the closure of Sana’a airport, made tackling the epidemic even harder, said Pritchard. “The region’s poorest country is on the verge of total collapse, and children are dying because they’re not able to access basic healthcare.”
Dr Nevio Zagaria, head of the World Health Organisation’s office in Yemen, said it is focusing on “hot spots” that are the sources of the disease. More than half of all cholera cases so far have been in Sana’a, Amran, Hajjah and Hodeidah (pdf). “Stamp out cholera in these places and we can slow the spread of the disease and save lives. At the same time, we’re continuing to support early and proper treatment for the sick and conducting prevention activities across the country,” he said.